Exercise systolic blood pressures are of questionable value in the assessment of the adult with a previous coarctation repair. (Congenital Heart Disease).

Background: The role of exercise testing in the follow up of adults with a coarctation repair is unclear. Exercise induced systolic hypertension has been advocated as an indication for further investigation; however, the value of exercise testing in this role has been questioned, especially in paediatric populations.

Objective: To assess the value of resting and exercise blood pressure measurements in a cohort of adults with repaired coarctation.

Setting: Tertiary referral centre for adult congenital cardiac disease.

Patients: 56 patients (33 male, 23 female) with a previous coarctation repair, and 33 age matched controls.

Main outcome measures: Resting and exercise blood pressures, including arm-leg systolic blood pressure gradients; standard echocardiographic measurements of left ventricular mass, aortic root diameter, and repair site gradient.

Results: The coarctation cohort had higher resting upper limb blood pressures than the controls (systolic: 129.7 v l20.7 mm Hg, p = 0.014; diastolic: 76.8 v 72.2 mm Hg, p = 0.02). Mean resting arm-leg systolic blood pressure gradient was also higher, at 3.6 v-2.2 mm Hg, p = 0.027. However, there were no differences between the peak exercise systolic blood pressures of the two groups. Peak exercise systolic blood pressure did not correlate with resting arm-leg blood pressure gradient (r = 0.24, p = 0.1 3) or with repair site gradient (r = 0.14, p = 0.39). Resting upper limb systolic blood pressure and resting arm-leg systolic blood pressure gradient were related to repair site gradient (r = 0.33, p = 0.03, and r = 0.47, p = 0.002).

Conclusions: Measurements of upper limb blood pressure during exercise are of limited value in the assessment of the post-repair coarctation patient. If routine exercise testing is to be advocated in this population it must be for another indication.

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It has been advocated that exercise testing is an essential part of the postsurgical follow up of the patient with a coarctation repair. (1) The indications for this assessment have included detection of aortic recoarctation and identification of patients with abnormally raised exercise systolic blood pressure. (2) Recoarctation is not uncommon in this population (3) and can be effectively treated with a wide range of surgical and transcatheter techniques. (4) Magnetic resonance imaging has greatly facilitated the diagnosis of recoarctation but is not always available, particularly in non-specialist centres. The clinician therefore has a limited number of diagnostic tools to determine which patients should be investigated further. The value of the exercise test in this role remains unclear, (5) and our aim in the present study was to investigate the relative usefulness of upper and lower limb blood pressures at rest and following exercise in a cohort of adults with repaired coarctation.

METHODS

Patients

Consecutive adults with repaired coarctation attending the outpatient clinic of the University of Toronto Congenital Cardiac Centre for Adults were identified from the institute's database. Patients were invited to participate in the study when attending their review appointment. Exclusion criteria were: any degree of left ventricular outflow tract obstruction (defined as an echo Doppler gradient of more than 16mm Hg on their last echocardiographic examination); patients with known coronary artery disease; and patients …