Background:
Detection of recoarctation is a main focus in follow-up programs for aortic coarctation and reinterventions are frequent. Both arm-leg-gradient in systolic blood pressure and exercise hypertension are known to be influenced by general changes in arterial reactivity and aortic stiffness and these are inappropriate tests to indicate recoarctation. Catheterization, MRI and CT-scan are technical demanding and expensive. We investigated if exercise echocardiography can give additional indications of recoarctation.
Methods:
Thirty-two patients (male/female 19/13) age 15 to 17 years formerly treated for coarctation without clinical symptoms of recoarctation were examined by echocardiography at rest and during supine incremental cycling until exhaustion (WHO-protocol).
Results:
Mean of systolic peak velocity in the descending aorta (VDAo) at rest was 2.2 m/s (SD 0.52). Mean of maximal VDAo during exercise was 3.5 m/s (SD 0.78). Mean of maximal systolic blood pressure during exercise was 211 mmHg (SD 34.3). Maximal VDAo was positively correlated to maximal systolic blood pressure (r=0.533, p=0.002). Nineteen individuals had a positive arm-leg-gradient (> 0 mmHg). All individuals with maximal VDAo ≥ 4.0 m/s (n= 8) had a positive arm-leg-gradient and six (75%) had prominent diastolic flow during peak exercise. Of 24 individuals with maximal VDAo < 4.0 m/s 11 (46%) had a positive arm-leg-gradient and six (25%) had prominent diastolic flow.
Conclusion:
Exercise echocardiography gives additional data in adolescent patients treated for aortic coarctation. Exercise echocardiography may facilitate discrimination between general vascular changes and recoarctation when a positive arm-leg-gradient of systolic blood pressure at rest is found.