Impact of Treatment Modality on Vascular Function in Coarctation of the Aorta: The LOVE - COARCT Study

José D Martins, Justin Zachariah, Elif Seda Selamet Tierney, Uyen Truong, Shaine A Morris, Shelby Kutty, Sarah D de Ferranti, Maria Guarino, Boban Thomas, Diana Oliveira, António Marinho, Marta António, Kimberlee Gauvreau, Nuno Jalles, Tal Geva, Miguel M Carmo, Ashwin Prakash, LOVE‐COARCT Study, José D Martins, Justin Zachariah, Elif Seda Selamet Tierney, Uyen Truong, Shaine A Morris, Shelby Kutty, Sarah D de Ferranti, Maria Guarino, Boban Thomas, Diana Oliveira, António Marinho, Marta António, Kimberlee Gauvreau, Nuno Jalles, Tal Geva, Miguel M Carmo, Ashwin Prakash, LOVE‐COARCT Study

Abstract

Background Optimally treated patients with coarctation of the aorta remain at risk for late vascular dysfunction. The effect of treatment modality on vascular function is unknown. The LOVE-COARCT (Long-term Outcomes and Vascular Evaluation After Successful Coarctation of the Aorta Treatment) study was done to compare vascular function in patients with coarctation of the aorta treated with surgery, balloon dilation (BD), or stent implantation. Methods and Results In treated coarctation of the aorta patients without residual coarctation, we prospectively compared aortic stiffness by applanation tonometry and cardiac magnetic resonance; endothelial function by endothelial pulse amplitude testing; blood pressure ( BP ) phenotype by office BP , ambulatory BP monitoring, and BP response to exercise; left ventricular mass by cardiac magnetic resonance; and blood biomarkers of endothelial function, inflammation, vascular wall function, and extracellular matrix. Participants included 75 patients treated with surgery (n=28), BD (n=23), or stent (n=24). Groups had similar age at enrollment, coarctation of the aorta severity, residual gradient, and metabolic profile, but differed by age at treatment. Prevalence of systemic hypertension, aortic stiffness, endothelial function, and left ventricular mass were similar among treatment groups. However, BD patients had more-distensible ascending aortas, lower peak systolic BP during exercise, less impairment in diurnal BP variation, and lower inflammatory biomarkers. Results were unchanged after adjustment for potential confounders, including age at treatment. Conclusions In our cohort of patients without residual coarctation, treatment modality was not associated with major vascular outcomes, even though there were some favorable vascular characteristics in the BD patients. Although this suggests that choice of treatment modality should continue to be driven by likelihood of achieving a good anatomical result, more long-term studies are required to assess the clinical significance of the more-optimal results of secondary markers of vascular function in BD patients. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 03262753.

Trial registration: ClinicalTrials.gov NCT03262753.

Keywords: arterial stiffness; coarctation of the aorta; long‐term outcome; pulse wave velocity; vascular function.

Figures

Figure 1
Figure 1
Comparison of key vascular function parameters between groups. Box and whisker plot of selected study variables. Boxes represent mean±2 SDs, and whiskers represent minimum and maximum values. Blue is balloon dilation; red is surgery; and green is stent. AAO indicates ascending aorta; BSA, body surface area; cfPWV, carotid‐femoral pulse wave velocity; CMR, cardiac magnetic resonance; Endo‐PAT, endothelial pulse amplitude testing; hs‐CRP, high‐sensitivity C‐reactive protein; IL‐1β, interleukin 1 beta; LV, left ventricle; MMP‐9, matrix metalloprotease 9; PWV, pulse wave velocity; SBP, systolic blood pressure; TGF‐β1, transforming growth factor beta‐1.

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