Factors Associated With an Abnormal Blood Pressure Response During Exercise After Coarctation Repair

2021 ◽  
Vol 13 (1) ◽  
pp. 53-59
Author(s):  
Mia Pivirotto ◽  
Michael F. Swartz ◽  
Megan B. McGreevy ◽  
Nader Atallah-Yunes ◽  
Jill M. Cholette ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Arch ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Exercise Stress ◽  
Factors Associated ◽  
Coarctation Repair ◽  
Brachiocephalic Trunk ◽  
Aortic Arch Repair

Background Although resting blood pressures following aortic arch repair or the extended end-to-end anastomosis (EEA) repair for coarctation can be physiologic, factors associated with an abnormal blood pressure response after exercise are unknown. We measured blood pressure gradients following exercise in children who had undergone previous repair in accordance with a surgical selection algorithm and sought to identify factors associated with an abnormal blood pressure response. Methods In accordance with our practice's surgical algorithm for repair of coarctation, infants were stratified to aortic arch repair when the distal transverse arch-to-left carotid artery ratio (DTA:LCA) ≤ 1.0, or when a brachiocephalic trunk or intra-cardiac lesion requiring repair was present. A thoracotomy and EEA were otherwise used. A follow-up exercise stress test (EST) measured the arm:leg blood pressure gradient after exercise, and a gradient ≥ 20 mm Hg was defined as an abnormal blood pressure response. Results Thirty-seven infants who had previously undergone coarctation repair (aortic arch repair-19, EEA-18) completed an EST at 12.3 ± 2.2 years of age. Thirteen (35%) children (aortic arch repair-5, EEA-8; p = .3) exhibited an abnormal blood pressure response. Factors associated with an abnormal blood pressure response included: smaller DTA:LCA ratios prior to repair (1.0 ± .2 vs. 1.2 ± .3; p = .04) and greater body weight at the time of EST (57.5 ± 19.1 vs. 40.9 ± 15.6 kg; p = .03). Conclusion An abnormal blood pressure response following exercise is associated with smaller DTA:LCA ratios at the time of repair and increased weight during follow-up suggesting that patients with these factors warrant close observation.

scholarly journals Systolic Blood Pressure Response to Exercise Stress Test and Risk of Stroke

Stroke ◽  
2001 ◽  
Vol 32 (9) ◽  
pp. 2036-2041 ◽  
Author(s):  
S. Kurl ◽  
J.A. Laukkanen ◽  
R. Rauramaa ◽  
T.A. Lakka ◽  
J. Sivenius ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Blood Pressure Response ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Pressure Response ◽  
Exercise Stress ◽  
Response To Exercise

scholarly journals Estimation of the Blood Pressure Response With Exercise Stress Testing

2019 ◽  
Vol 28 (5) ◽  
pp. 742-751 ◽  
Author(s):  
Benjamin T. Fitzgerald ◽  
Emma L. Ballard ◽  
Gregory M. Scalia
Keyword(s):  
Blood Pressure ◽  
Stress Testing ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Exercise Stress ◽  
Exercise Stress Testing

scholarly journals HEPATIC STEATOSIS IS INDEPENDENTLY ASSOCIATED WITH HYPERREACTIVE BLOOD PRESSURE RESPONSE ON THE EXERCISE STRESS TEST

2012 ◽  
Vol 59 (13) ◽  
pp. E1793
Author(s):  
Antonio Laurinavicius ◽  
Fernando Nary ◽  
Michael Blaha ◽  
Khurram Nasir ◽  
Raquel Conceicao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hepatic Steatosis ◽  
Blood Pressure Response ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Pressure Response ◽  
Exercise Stress

scholarly journals Surgical Aortic Arch Intervention at the time of Extended Ascending Aortic Replacement is Associated with Increased Mortality

2021 ◽  
Author(s):  
Michael Bowdish ◽  
Daniel Logsdon ◽  
Ramsey Elsayed ◽  
Wendy Mack ◽  
Brittany Abt ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Ascending Aorta ◽  
Conservative Approach ◽  
Factors Associated ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Aortic Arch Repair ◽  
Multivariable Models ◽  
Patch Technique

Objective: To compare outcomes of hemiarch versus total arch repair during extended ascending aortic replacement. Methods: Between 2004 and 2017, 261 patients underwent hemiarch (n=149, 57%) or total arch repair (aortic debranching or Carrell patch technique, n=112, 43%) in the setting of extended replacement of the ascending aorta. Median follow-up was 17.2 (IQR 4.2–39.1) months. Multivariable models considering preoperative and intraoperative factors associated with mortality and aortic reintervention were constructed. Results: Survival was 89.0, 81.3, and 73.5% vs. 76.4, 69.5, and 61.7% at 1, 3, and 5 years in the hemiarch versus total arch groups, respectively (log-rank p=0.010). After adjustment for preoperative and intraoperative factors, the presence of a total arch repair (adjusted HR 2.53, 95% CI 1.39 – 4.62, p=0.003), and increasing age (adjusted HR per 10 years of age, 1.76, 95% CI 1.37 – 2.28, p<0.001) were associated with increased mortality. The cumulative incidence of aortic reintervention with death as a competing outcome was 2.6, 2.6, and 4.4% and 5.0, 10.3, and 11.9% in the hemiarch and total arch groups, respectively. After adjustment, the presence of a total arch repair was significantly associated with need for aortic reintervention (SHR 3.21, 95% CI 1.01 – 10.2, p=0.047). Conclusions: Overall survival after aortic arch repair in the setting of extended ascending aortic replacement is excellent, however, total arch repair and increasing age are associated with higher mortality and reintervention rates. A conservative approach to aortic arch repair can be prudent, especially in those of advanced age.

Abstract 2552: Hypertrophic Cardiomyopathy in Children: Do Adult Risk Factors for Cardiac Death Apply

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jamie A Decker ◽  
Joseph W Rossano ◽  
E. O’Brian Smith ◽  
Bryan C Cannon ◽  
Sarah K Clunie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Hypertrophic Cardiomyopathy ◽  
Family History ◽  
Blood Pressure Response ◽  
Left Ventricular ◽  
Pressure Response ◽  
Systemic Hypertension ◽  
Response To Exercise

Introduction : Annual mortality in children with hypertrophic cardiomyopathy (HCM) has been reported to be 1– 6%. Risk factors for death in adult HCM patients have been characterized; their application to pediatric HCM is unknown. The purpose of this study was to correlate adult risk factors with outcomes in our pediatric population using a standard management strategy. Methods : A retrospective cohort study of children with HCM was performed. Death and cardiac transplant were the primary outcomes. Diagnosis was based on asymmetric septal or concentric hypertrophy as determined by echocardiography. Exclusion criteria included: genetic syndrome, mitochondrial or metabolic disorder, infants of diabetic mothers, congenital heart disease, systemic hypertension, diagnosis >18 years of age, or follow-up <1 year. Results : From 1/1/85 to 10/1/06, 96 patients met inclusion criteria. Mean age at diagnosis was 10.6 ± 5.4 years. Mean follow-up was 6.5 ± 5.2 years. 11 patients had an adverse outcome (7 deaths, 4 transplants). Kaplan-Meier analysis predicts an 82% survival over 20 years. Evidence of left ventricular outflow tract obstruction (LVOTO) occurred in =6% of patients, syncope in 23% and a family history for malignant HCM in 17%. Aborted sudden death occurred in 6%. 10% had non-sustained ventricular tachycardia. 58% of patients underwent at least one exercise treadmill test. All patients were restricted from strenuous activity. 95% of patients were on a β-blocker or calcium channel blocker, with 10% on both. Additional intervention depended on symptoms, family history, and degree of LVOTO. 17% had an implantable defibrillator (ICD). 10% were given a pacemaker due to LVOTO, and 5% underwent left ventricular myectomy. Only extreme LVH (>6 z-scores for BSA) and a blunted blood pressure response to exercise were statistically significant for worse outcomes (both p<0.02). Conclusions : A low mortality/transplantation rate occurred in children with isolated HCM whose management consisted of exercise restriction and medication, with or without an ICD. Management that included myectomy was uncommon. Patients with extreme LVH and a blunted blood pressure response to exercise are high-risk individuals.

scholarly journals Factors Associated With Blood Pressure Response to the Cold Pressor Test: The GenSalt Study

2013 ◽  
Vol 26 (9) ◽  
pp. 1132-1139 ◽  
Author(s):  
M. Zhang ◽  
Q. Zhao ◽  
K. T. Mills ◽  
J. Chen ◽  
J. Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Response ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Pressure Response ◽  
Factors Associated ◽  
Pressor Test

scholarly journals 248 Association between abnormal blood pressure response to exercise and incident cardiovascular events

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N16-N16
Author(s):  
Francesca Bellomo ◽  
Mariapaola Campisi ◽  
Giuseppe Lantone ◽  
Paolo Mazzone ◽  
Giorgio Firetto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Disease ◽  
Cardiovascular Events ◽  
Blood Pressure Response ◽  
Stress Test ◽  
Pressure Response ◽  
Exercise Stress ◽  
Control Group ◽  
Prognostic Impact ◽  
Pathophysiological Mechanism

Abstract Aims The aim of this multicentre registry was to verify the association between an exaggerated blood pressure response (EBPR) to exercise stress test (EST) and evidence of previous myocardial and/or brain ischaemic events in the general population. Methods and results All subjects who underwent EST for screening of ischaemic heart disease and/or follow-up and re-evaluation of heart disease were included in the registry. Patients who discontinued EST due to early muscle exhaustion, younger individuals (&lt;18 years), patients with potentially dangerous channelopathies or ventricular arrhythmias, as well as those with disabling chronic diseases or experiencing cardiovascular events in the 3 months prior to TE. Everyone performed EST on a treadmill or cycle ergometer using similar protocols in the various centres. Based on some study in the literature, we identified the EBPR to exercise for a systolic BP rise &gt;60 mmHg (men) or &gt; 50 mmHg (women) compared to pre-exercise baseline measurement, but also an absolute value &gt;210 or &gt; 190 mmHg, respectively. Retrospectively, we verified the presence of non-disabling ischaemic cardiac and cerebrovascular events over the past 10 years. Five hundred and three subjects of mean age 61 ± 11 years were included in the registry. EST was performed on a treadmill in 65% of subjects and maximal workload was achieved by 75% of them. Subjects with EBPR were 170 (34%) vs. 333 (66%) who had normal response (controls). EBPR group included most male subjects, often overweight and with a higher prevalence of diabetes (31% vs. 20% in the control group, P &lt; 0.01), and with already diagnosed arterial hypertension in a half of cases. Previous ischaemic myocardial events were found in 35% of EBPR subjects vs. 36% of controls (P = NS), while cerebrovascular disease in 20% vs. 10%, respectively (P &lt; 0.005). Conclusion Albeit retrospectively performed, this multicentre registry highlighted an association between EBPR to exercise (present in more than one-third of the subjects examined, especially males) and history of cerebrovascular ischaemic events within 10 years prior to enrolment. In line with previous studies, present data confirmed a clinical impact of EBPR on exercise. However, the precise pathophysiological mechanism(s) need to be clarified yet, also in terms of therapies against such exaggerated functional response and its possible prognostic impact over time.

Sign in / Sign up

Export Citation Format

Share Document