Effect of Combined Ventricular-Arterial Stiffening on Exercise Hemodynamics in Adults with Repaired Coarctation of Aorta

ABSTRACT Background Patients with coarctation of aorta (COA) have arterial stiffening, and this is associated with impaired cardiac reserve and hypertensive systolic blood pressure (SBP) response during exercise. However, whether COA patients have concomitant left ventricular (LV) stiffening, and the potential impact of combined ventricular-arterial stiffening on exercise hemodynamics are unknown. Methods We studied 174 patients with repaired COA (age 39±11 years and male 103 [59%]) and 174 matched controls. Our study hypotheses are: (1) COA patients have higher ventricular-arterial stiffness (end-systolic elastance [Ees] and arterial elastance, [Ea]) as compared to controls; (2) ventricular-arterial stiffness was associated with LV stroke volume augmentation (ΔLVSV) and SBP augmentation (ΔSBP) with during exercise among COA patients. Results Despite similar systolic SBP, COA patients had higher Ea (1.8±0.4 vs 1.4±0.4 mmHg/ml, p Conclusion Patients with COA had combined ventricular-arterial stiffening, and this was associated with impaired cardiac reserve and hypertensive SBP response during exercise. These findings provide foundation for further studies to determine whether drugs that reduce both ventricular and arterial stiffness will improve exercise capacity and hemodynamics in this unique population.