Prevalence of Ambulatory Hypertension, Hemodynamic Phenotypes, and Subclinical Myocardial Dysfunction After Coarctation of the Aorta Repair
DOI:
https://doi.org/10.62438/tunismed.v104i09.7179Keywords:
Aortic Coarctation, Blood Pressure Monitoring, Ambulatory , Hypertension, Hypertrophy, Left Ventricular, Echocardiography, ChildAbstract
Introduction: Arterial hypertension is the leading long-term complication after coarctation of the aorta (CoA) repair. Ambulatory blood pressure monitoring (ABPM) phenotyping combined with speckle-tracking echocardiography remains undercharacterized in pediatric and young adult cohorts, with no data from North Africa.
Aim: To describe the prevalence and hemodynamic phenotypes of ABPM-defined hypertension, evaluate subclinical myocardial dysfunction by global longitudinal strain (GLS), and identify independent predictors of ambulatory hypertension after CoA repair.
Methods: A cross-sectional study at CHU Sahloul, Sousse, Tunisia, included 30 patients aged 5 to 30 years after isolated CoA repair. ABPM was classified using age-appropriate guidelines. Speckle-tracking-derived GLS was assessed in all patients. Predictors of ABPM-defined hypertension were identified by multivariable logistic regression.
Results: ABPM-defined hypertension was identified in 13 patients (43.3%): sustained ambulatory hypertension in 11 (36.7%) and masked hypertension in 2 (6.7%). White-coat hypertension was absent. Left ventricular hypertrophy (LVH) was present in 7 patients (23.3%) and reduced
GLS in 8 (26.7%) despite universally preserved left ventricular ejection fraction (LVEF, mean 57.5 ± 3.1%). The peak isthmic Doppler gradient was the sole independent predictor of ABPM-defined hypertension (adjusted OR 1.16 per mmHg; 95% CI 1.03 to 1.31; p = 0.016).
Conclusion: ABPM reveals a substantial hypertension burden after CoA repair characterized by complete absence of white-coat hypertension. The peak isthmic Doppler gradient independently predicts ambulatory hypertension and should be systematically quantified at follow-up
echocardiography. Speckle-tracking echocardiography identifies subclinical myocardial dysfunction in patients with preserved LVEF.
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