Juliana Lasso-Mendez MSc , Christopher Spence MD , Lisa K. Hornberger MD , Allison Sivak PhD , Margie H. Davenport PhD
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引用次数: 0
Abstract
Background
Congenital heart disease (CHD) affects 1% of live births and is a risk factor for cardiovascular disease and reduced life expectancy. Previous studies have suggested CHD is associated with impaired vascular health, but this has not been established. Therefore, the objective of this study was to examine the effect of CHD on vascular health.
Methods
Eight electronic databases were searched through April 12, 2024. Studies of all designs (except case studies and reviews) that reported on the population (individuals with CHD of any age), comparator (individuals without CHD), and outcomes of interest: endothelial dependent (flow-mediated vasodilation, reactive hyperemia index) and independent (nitroglycerin-mediated dilation) vascular function, arterial stiffness (pulse wave velocity, stiffness index, augmentation index, distensibility, and compliance), and carotid intima-media thickness were included. Results are presented as standardized mean difference (SMD) with 95% confidence interval (CI) and as effect size.
Results
We included 138 studies (N = 16,115) in the meta-analysis. Individuals with CHD exhibited decreased vascular function compared with those without including decreased low-mediated vasodilation (SMD, -0.96 [95% CI, -1.22 to -0.70]; I2 = 85%; large effect size), reactive hyperemia index using ultrasound (SMD, -2.88 [95% CI, -4.85 to -0.90]; I2 = 96%; large effect size), and nitroglycerin-mediated dilation (SMD, -0.98 [95% CI, -1.35 to -0.61]; I2 = 87%; large effect size). Various CHD subtypes including coarctation of the aorta, transposition of the great arteries, and tetralogy of Fallot, after the Fontan procedure showed significant vascular dysfunction. Shunt lesions did not show significant vascular dysfunction.
Conclusions
CHD is associated with vascular dysfunction, increased arterial stiffness, and greater carotid intima-media thickness in pediatric and adult patients.
期刊介绍:
The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.