Increased arterial stiffness in children with congenital heart disease

Objective: Central systolic blood pressure (SBP) is a measure of arterial stiffness and strongly associated with atherosclerosis and end-organ damage. It is a stronger predictor of cardiovascular events and all-cause mortality than peripheral SBP. In particular, for children with congenital heart disease, a higher central SBP might impose a greater threat of cardiac damage. The aim of the study was to analyse and compare central SBP in children with congenital heart disease and in healthy counterparts. Patients and methods: Central SBP was measured using an oscillometric method in 417 children (38.9% girls, 13.0±3.2 years) with various congenital heart diseases between July 2014 and February 2017. The test results were compared with a recent healthy reference cohort of 1466 children (49.5% girls, 12.9±2.5 years). Results: After correction for several covariates in a general linear model, central SBP of children with congenital heart disease was significantly increased (congenital heart disease: 102.1±10.2 vs. healthy reference cohort: 100.4±8.6, p <.001). The analysis of congenital heart disease subgroups revealed higher central SBP in children with left heart obstructions (mean difference: 3.6 mmHg, p <.001), transpositions of the great arteries after arterial switch (mean difference: 2.2 mmHg, p =.017) and univentricular hearts after total cavopulmonary connection (mean difference: 2.1 mmHg, p =.015) compared with the reference. Conclusion: Children with congenital heart disease have significantly higher central SBP compared with healthy peers, predisposing them to premature heart failure. Screening and long-term observations of central SBP in children with congenital heart disease seems warranted in order to evaluate the need for treatment.