CONGENITAL HEART DISEASE

Exercise systolic blood pressures are of questionable value in the assessment of the adult with a previous coarctation repair

L Swan¹, S Goyal², C Hsia², S Hechter², G Webb² and M A Gatzoulis¹

¹ Adult Congenital Heart Programme, Royal Brompton Hospital, London, UK
² Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, Canada

Correspondence to:
Correspondence to:
Dr Lorna Swan, Toronto Congenital Cardiac Centre for Adults, 12th floor Eaton North, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada;
lornaswan{at}yahoo.com

Background: The role of exercise testing in the follow up of adults with a coarctation repair is unclear. Exercise induced systolic hypertension has been advocated as an indication for further investigation; however, the value of exercise testing in this role has been questioned, especially in paediatric populations.

Objective: To assess the value of resting and exercise blood pressure measurements in a cohort of adults with repaired coarctation.

Setting: Tertiary referral centre for adult congenital cardiac disease.

Patients: 56 patients (33 male, 23 female) with a previous coarctation repair, and 33 age matched controls.

Main outcome measures: Resting and exercise blood pressures, including arm–leg systolic blood pressure gradients; standard echocardiographic measurements of left ventricular mass, aortic root diameter, and repair site gradient.

Results: The coarctation cohort had higher resting upper limb blood pressures than the controls (systolic: 129.7 v 120.7 mm Hg, p = 0.014; diastolic: 76.8 v 72.2 mm Hg, p = 0.02). Mean resting arm–leg systolic blood pressure gradient was also higher, at 3.6 v -2.2 mm Hg, p = 0.027. However, there were no differences between the peak exercise systolic blood pressures of the two groups. Peak exercise systolic blood pressure did not correlate with resting arm–leg blood pressure gradient (r = 0.24, p = 0.13) or with repair site gradient (r = 0.14, p = 0.39). Resting upper limb systolic blood pressure and resting arm–leg systolic blood pressure gradient were related to repair site gradient (r = 0.33, p = 0.03, and r = 0.47, p = 0.002).

Conclusions: Measurements of upper limb blood pressure during exercise are of limited value in the assessment of the post-repair coarctation patient. If routine exercise testing is to be advocated in this population it must be for another indication.

Keywords: coarctation; blood pressure; exercise

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