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This study aims to assess:
Coarctation of the aorta (CoA) is a congenital narrowing of the aortic lumen, accounting for 5-8% of congenital heart diseases, with an incidence of 1 in 3000-4000 live births . This narrowing leads to altered hemodynamics, including increased left ventricular afterload, systemic hypertension, and long-term vascular remodeling, which can persist even after anatomical correction .
Despite advances in interventions like stent implantation for native or recurrent CoA, many patients remain hypertensive post-procedure . This residual hypertension may not be purely mechanical but linked to persistent vascular dysfunction, abnormal aortic compliance, or inadequate aortic wall remodeling .
Aortic stiffness is now recognized as a key cardiovascular risk factor in CoA patients . Reduced elasticity contributes to high systolic blood pressure, increased cardiac workload, and late cardiovascular complications [7]. Moreover, abnormal aortic arch geometry-particularly the "gothic arch"-has been linked to impaired vascular function and unfavorable hemodynamics [13].
While cardiac magnetic resonance (CMR) is the standard for evaluating aortic stiffness and ventricular function , CT Aortography offers high-resolution images to assess aortic distensibility, luminal changes, and residual stenosis, especially post-stenting . When combined with blood pressure and ECG data, these insights can provide a fuller picture of outcomes .
This study investigates the relationship between post-stenting blood pressure and aortic geometry-including arch shape and residual stenosis-using CT Aortography in CoA patients. It also explores ECG changes as potential non-invasive markers of ventricular strain and hemodynamic stress ..
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| COA patients |
| ||
| Healthy controls |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CT aortography | Radiation | Performed before and after stenting using a multidetector CT scanner (device model and parameters to be specified). Analysis will include:
Ascending aorta (AA), Proximal descending thoracic aorta (PDA), At the level of the diaphragm (DA), Abdominal aorta (AbAo). - Aortic tortuosity. All CT data will be interpreted by two independent observers blinded to clinical outcomes |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Systolic Blood Pressure | Difference in systolic blood pressure between baseline (pre-stenting) and 6 months post-stenting using standardized clinical sphygmomanometer. Unit of Measure: mmHg | Baseline and 6 months post-stenting |
| Change in Diastolic Blood Pressure | Difference in diastolic blood pressure between baseline (pre-stenting) and 6 months post-stenting using standardized clinical sphygmomanometer. Unit of Measure: mmHg | Baseline and 6 months post-stenting |
| Measure | Description | Time Frame |
|---|---|---|
| Aortic Arch Morphology Classification | Classification of aortic arch morphology (normal, gothic, crenel) based on CT aortography. Unit of Measure: Categorical (normal/gothic/crenel) | Baseline (within hospital stay, up to 2 days) |
| Aortic Elasticity |
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Inclusion Criteria:
Age ≥ 12 years.
Diagnosed with native or recurrent coarctation of the aorta.
Transcatheter systolic pressure gradient ≥ 20 mmHg.
Body weight ≥ 20 kg.
Availability of pre- and post-stenting CT aortography data.
Exclusion Criteria:
Patients with obstructive lesion of LVOT or aortic valve dysfunction greater than moderate (requiring surgical intervention)..
Patients with other causes of secondary hypertension.
Associated complex congenital heart defects (aside from simple septal defects and patent ductus arteriosus)
Genetic syndromes
Connective tissue disorder
History of surgery involving the aortic root or ascending aorta.
Incomplete imaging or missing data relevant to the study.
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The study population will consist of two groups:
All participants will undergo imaging and functional evaluation including CT aortography, cardiac MRI, 24-hour ambulatory blood pressure monitoring (ABPM), and ECG as part of the study protocol.
The study will be conducted at [Assiut University Hospital / Orman Cardiology Center - modify as needed], and participants will be recruited from the cardiology outpatient clinics and imaging units.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mena Wadee, Resident doctor | Contact | 01282210873 | menawade399@gmail.com | |
| Noha Gamal | Contact | +201002295166 | noha_cardio@aun.edu.eg |
| Name | Affiliation | Role |
|---|---|---|
| Salwa Demitry Roshdy, Professor | Faculty of medicine AssiutU university | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Institutional Review Board (IRB) of Faculty of Medicine | Asyut | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25559379 | Result | Shepherd B, Abbas A, McParland P, Fitzsimmons S, Shambrook J, Peebles C, Brown I, Harden S. MRI in adult patients with aortic coarctation: diagnosis and follow-up. Clin Radiol. 2015 Apr;70(4):433-45. doi: 10.1016/j.crad.2014.12.005. Epub 2015 Jan 3. | |
| 11867038 | Result | Toro-Salazar OH, Steinberger J, Thomas W, Rocchini AP, Carpenter B, Moller JH. Long-term follow-up of patients after coarctation of the aorta repair. Am J Cardiol. 2002 Mar 1;89(5):541-7. doi: 10.1016/s0002-9149(01)02293-7. |
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| CMR | Radiation | CMR examinations will be performed using a commercially available 1.5 Tesla whole-body scanner (Ingenia, Philips Healthcare, release 4.1.3.0). In pediatric or uncooperative patients, free-breathing sequences were used when breath-holding was not feasible. Brachial blood pressure was measured in the right arm in the supine position immediately before image acquisition using automated oscillometric devices. Cine steady-state free precession (SSFP) sequences were obtained in multiple views including the short axis of the ascending aorta (AAO) and descending aorta (DAO), as well as the aortic root to evaluate aortic valve morphology (bicuspid vs tricuspid). Left ventricular (LV) and left atrial (LA) functional parameters were assessed by standard volumetric analysis. The following CMR-derived parameters were collected: Left ventricular ejection fraction (LVEF) Left ventricular strain Left ventricular mass index (LVMI) Left atrial volume Left atrial strain LV and LA strain were analyzed usi |
|
Aortic elasticity calculated from CT aortography using (ΔA/A)/ΔP, where A is cross-sectional area and P is pulse pressure.
Unit of Measure: mm²/mmHg
| Baseline and 6 months post-stenting |
| Aortic Distensibility | Aortic distensibility measured from CT aortography. Unit of Measure: mmHg-¹ | Baseline and 6 months post-stenting |
| Aortic Arch Angle | Aortic arch angle measured from CT aortography. Unit of Measure: degrees | Baseline and 6 months post-stenting |
| Aortic Arch Curvature | Curvature of the aortic arch measured from CT aortography. Unit of Measure: cm-¹ | Baseline and 6 months post-stenting |
| Residual Stenosis | Percentage of luminal narrowing remaining after stent implantation measured by CT angiography. Unit of Measure: % | 6 months post-stenting |
| Left Ventricular Ejection Fraction (LVEF) | Description: LVEF measured by cardiac MRI. Unit of Measure: % | Baseline and 6 months post-stenting |
| LV Global Longitudinal Strain | LV global longitudinal strain measured by cardiac MRI. Unit of Measure: % | Baseline and 6 months post-stenting |
| LV Mass Index (LVMI) | LV mass indexed to body surface area measured by cardiac MRI. Unit of Measure: g/m² | Baseline and 6 months post-stenting |
| Left Atrial Volume Index (LAVI) | Description: Left atrial volume indexed to body surface area measured by cardiac MRI. Unit of Measure: mL/m² | Baseline and 6 months post-stenting |
| QTc Dispersion | QTc dispersion measured from 12-lead ECG using Bazett's formula. Unit of Measure: milliseconds | Baseline and 6 months post-stenting |
| Presence of Left Ventricular Hypertrophy on ECG | Detection of LV hypertrophy based on standard ECG voltage criteria. Unit of Measure: Categorical (present/absent) | Baseline and 6 months post-stenting |
| Presence of Arrhythmia | Detection of arrhythmias using standard 12-lead ECG or Holter monitoring. Unit of Measure: Categorical (present/absent) | Baseline and 6 months post-stenting |
| 18622223 | Result | Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, Kario K, Lurbe E, Manolis A, Mengden T, O'Brien E, Ohkubo T, Padfield P, Palatini P, Pickering T, Redon J, Revera M, Ruilope LM, Shennan A, Staessen JA, Tisler A, Waeber B, Zanchetti A, Mancia G; ESH Working Group on Blood Pressure Monitoring. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring. J Hypertens. 2008 Aug;26(8):1505-26. doi: 10.1097/HJH.0b013e328308da66. |
| 30585428 | Result | Iriart X, Laik J, Cremer A, Martin C, Pillois X, Jalal Z, Roubertie F, Thambo JB. Predictive factors for residual hypertension following aortic coarctation stenting. J Clin Hypertens (Greenwich). 2019 Feb;21(2):291-298. doi: 10.1111/jch.13452. Epub 2018 Dec 25. |
| 31730044 | Result | Pushparajah K, Duong P, Mathur S, Babu-Narayan S. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Cardiovascular MRI and CT in congenital heart disease. Echo Res Pract. 2019 Oct 1;6(4):R121-38. doi: 10.1530/ERP-19-0048. Online ahead of print. |
| 29940971 | Result | Faganello G, Cioffi G, Rossini M, Ognibeni F, Giollo A, Fisicaro M, Russo G, Di Nora C, Doimo S, Tarantini L, Mazzone C, Cherubini A, D'Agata Mottolesi B, Pandullo C, Di Lenarda A, Sinagra G, Viapiana O. Are aortic coarctation and rheumatoid arthritis different models of aortic stiffness? Data from an echocardiographic study. Cardiovasc Ultrasound. 2018 Jun 26;16(1):9. doi: 10.1186/s12947-018-0126-y. |
| 32547712 | Result | Agasthi P, Pujari SH, Tseng A, Graziano JN, Marcotte F, Majdalany D, Mookadam F, Hagler DJ, Arsanjani R. Management of adults with coarctation of aorta. World J Cardiol. 2020 May 26;12(5):167-191. doi: 10.4330/wjc.v12.i5.167. |
| 17059930 | Result | Ou P, Mousseaux E, Celermajer DS, Pedroni E, Vouhe P, Sidi D, Bonnet D. Aortic arch shape deformation after coarctation surgery: effect on blood pressure response. J Thorac Cardiovasc Surg. 2006 Nov;132(5):1105-11. doi: 10.1016/j.jtcvs.2006.05.061. |
| 15474701 | Result | Ou P, Bonnet D, Auriacombe L, Pedroni E, Balleux F, Sidi D, Mousseaux E. Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta. Eur Heart J. 2004 Oct;25(20):1853-9. doi: 10.1016/j.ehj.2004.07.021. |
| 27084076 | Result | Vonder Muhll IF, Sehgal T, Paterson DI. The Adult With Repaired Coarctation: Need for Lifelong Surveillance. Can J Cardiol. 2016 Aug;32(8):1038.e11-5. doi: 10.1016/j.cjca.2015.12.036. Epub 2016 Jan 21. |
| ID | Term |
|---|---|
| D066253 | Vascular Remodeling |
| D001017 | Aortic Coarctation |
| ID | Term |
|---|---|
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010335 | Pathologic Processes |
| D006330 | Heart Defects, Congenital |
| D018376 | Cardiovascular Abnormalities |
| D002318 | Cardiovascular Diseases |
| D006331 | Heart Diseases |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
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