Cardiopulmonary exercise test in the evaluation of exercise capacity, arterial hypertension, and degree of descending aorta stenosis in adults after repair of coarctation of the aorta

Abstract

Background: Despite effective repair of coarctation of the aorta (CoAo), arterial hypertension (AH) and early coronary artery disease that may result in heart failure. The aim of the study was to evaluate exercise capacity by a cardiopulmonary exercise test in patients after of CoAo repair, and to determine relations between these parameters and the presence of AH, residual stenosis of the descending aorta (AoD) and the patient’s age at the time of the surgery.
Methods: 74 patients at mean age 31.2 ± 9.8 years. The controls: 30 at mean age 32.2 ± 6.6. Descending aorta (AoD) gradient was evaluated by echocardiography. The group with residual AoD stenosis: ≥ 25 mm Hg (AoD+) 32 patients and AoD–: 41 patients. Subgroups without AH (AH–, n = 32), exercise-induced AH (AHex, n = 10), persistent AH (AH+, n = 32). The maximum exercise test was performed.
Results: A comparison of the study and control groups: VO₂max: p = 0.0001), VO₂max%: p=0.0001 and VE/VCO₂: p = 0.001. Negative correlation: between VO2max and the age at the time of surgery: p = 0.004) and a positive: between VE/VCO2 and age at surgery: p = 0.005. No differences were observed between the AoD+ and AoD– groups with respect to cardiopulmonary parameters. A comparison of the AH+ and AH– groups revealed: VO₂max: p = 0.01, VO₂max%: p = 0.02 and VE/VCO₂: p = 0.003. A comparison of the AHex and AH– groups showed VE/VCO₂: p = 0.01.
Conclusions: The exercise capacity of adults after surgical CoAo repair is reduced. This is more pronounced in patients with AH and those operated on at a more advanced age, but not in AoD+. (Cardiol J 2007; 14: 76–82)