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Echocardiography during submaximal isometric exercise in children with repaired coarctation of the aorta compared with controls
  1. Joseph Panzer,
  2. Laure Dequeker,
  3. Ilse Coomans,
  4. Kristof Vandekerckhove,
  5. Thierry Bove,
  6. Daniël De Wolf and
  7. Ernst Rietzschel
  1. Pediatric Cardiology and Cardiac Surgery Department, UZ Gent, Gent, Belgium
  1. Correspondence to Dr Joseph Panzer; Joseph.Panzer{at}UZGent.be

Abstract

Objective Patients with repaired coarctation (RCoA) remain at higher risk of cardiac dysfunction, initially often only detected during exercise. In this study, haemodynamics of isometric handgrip (HG) and bicycle ergometry (BE) were compared in patients with RCoA and matched controls (MCs).

Methods Case–control study of 19 children with RCoA (mean age 12.9±2.3 years; mean age of repair 7 months) compared with 20 MC. HG with echocardiography followed by BE was performed in both groups.

Results During HG (blood pressure) BP increased from 114±11/64±4 mm Hg to 132±14/79±7 mm Hg, without significant differences. During HG as well as BE, HR increased less in patients with RCoA. There were no significant differences in (left ventricle) LV dimensions or LV mass.

The RCoA group had diastolic dysfunction: both at rest and during HG they had significantly higher transmitral E and A velocities and lower tissue Doppler E′ and A′ velocities. E/E′ was higher, reaching statistical significance during HG (p<0001).

Conventional parameters of systolic function (FS and EF) were similar at rest and HG. More sensitive tissue Doppler S′ was significantly lower at rest in CoA subjects (5.1±1.5 cm/s vs 6.5±1±1 cm/s; p<0.01), decreasing further during HG by 5% in the CoA group (NS) while unchanged in controls.

Conclusions We provide first evidence that HG with echocardiography is feasible, easy and patient-friendly. A decreased systolic (tissue Doppler) and impaired diastolic LV function was measured in the RCoA group, a difference that tended to increase during HG.

  • congenital heart disease
  • paediatric cardiology
  • paediatric interventional cardiology
  • paediatric surgery
  • hypertensive heart disease

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Footnotes

  • Contributors All authors contributed to this manuscript in all four categories: substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics Board UZ Gent Belgian Registry Number: B670201214536. This investigation was reviewed and approved by the ethical committee of Ghent University Hospital (protocol number: B670201214886).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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