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. 2022 Jan 3:7:100319.
doi: 10.1016/j.ijcchd.2022.100319. eCollection 2022 Mar.

Common carotid artery characteristics in patients with repaired aortic coarctation compared to other cardiovascular risk factors

Anna Lindow  1 , Cecilia Kennbäck  2 , Anna Åkesson  3 , Peter M Nilsson  2 , Constance G Weismann  1   4
Affiliations

Common carotid artery characteristics in patients with repaired aortic coarctation compared to other cardiovascular risk factors

Anna Lindow et al. Int J Cardiol Congenit Heart Dis. .

Abstract

Aims: Increased common carotid artery (CCA) intima media thickness (cIMT) is a well-known risk factor for cardiovascular morbidity and mortality. cIMT thickening has been described in patients with repaired aortic coarctation (CoA), but data on mechanism and clinical relevance in this population are scarce. Our aim was to gain mechanistic insights into cIMT thickening of patients with repaired CoA by comparing their wall architecture to patients with coronary artery disease (CAD), other congenital heart diseases (oCHD), and healthy controls.

Methods and results: A total of 310 subjects were included (CoA (n ​= ​58), oCHD (n ​= ​96), CAD (n ​= ​68) and healthy controls (n ​= ​88)). CIMT and lumen diameter (LD) were determined using semiautomated analysis software. Linear regression analyses were performed correcting for relevant covariates. While patients with repaired CoA and CAD both had significantly increased cIMT and cIMT/LD ratios, LD was increased only in CoA patients. Furthermore, patients with repaired CoA had decreased CCA stiffness. CCA characteristics in the oCHD group were not significantly different from controls.

Conclusion: The mechanism of cIMT thickening in patients with repaired CoA may differ from CAD. While there is concentric remodeling in the latter, we see predominant eccentric remodeling in the CoA group, which could be due to increased flow as a result of compliance mismatch at the CoA repair site. We therefore suggest that the prognostic value of cIMT in post-CoA patients should be validated separately prior to using it to guide clinical management in this group.

Keywords: Aortic coarctation; Arterial stiffness; Common carotid artery; Congenital heart disease; Dimension; Intima media thickness.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Schematic figure of common carotid artery characteristics.
Fig. 2
Fig. 2
Illustration of the common carotid artery measurements. A, B, C were measured with Artery Measurement System. D was measured using Philips Intellispace Cardiovascular. A shows the trailing edge interface between the lumen and the intima in the near wall. B shows the leading edge interface between the lumen and the intima in the far wall. C shows the leading edge interface between adventitia and media in the far wall. A - B shows the lumen diameter. B - C shows the intima media thickness. D shows the lumen diameter, intima to intima.
Fig. 3
Fig. 3
Intima media thickness, lumen diameter, intima media thickness/lumen diameter ratio and diastolic circumferential wall stress of patients with repaired aortic coarctation, congenital heart diseases, coronary artery disease and healthy controls after correction for age and sex. Group “Congenital heart disease” represents the oCHD group. Data are derived from a Generalized Linear Model with Bonferroni correction and presented as estimated means (black filled circle) with 95% confidence interval (vertical line). Groups are compared to controls (p-value above the data points). In addition, aortic coarctation is compared to the coronary artery disease group (p-value below the data points).
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