Arterial-left ventricular-left atrial coupling late after repair of aortic coarctation and interruption

Li, Vivian Wing‐yi; Cheung, Yiu‐fai

doi:10.1093/ehjci/jeu309

Cited by 18 publications

(17 citation statements)

References 46 publications

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“…5). Successful repair of aortic coarctation in children and normotensive adults results in decreased aortic compliance upstream of the coarctation site (5,33,52,74). The documented changes in aortic compliance due to surgery are the inverse of our result illustrated in Fig.…”

Section: Judicious Use Of Simplifying Assumptions Allowed Identificatsupporting

confidence: 59%

Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses

Nguyen

Tüzün²,

Quick

2016

American Journal of Physiology-Regulatory, Integrative and Comp

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Nguyen PH, Tuzun E, Quick CM. Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses. Am J Physiol Regul Integr Comp Physiol 311: R522-R531, 2016. First published June 15, 2016 doi:10.1152/ajpregu.00402.2015.-Aortic pulse pressure arises from the interaction of the heart, the systemic arterial system, and peripheral microcirculations. The complex interaction between hemodynamics and arterial remodeling precludes the ability to experimentally ascribe changes in aortic pulse pressure to particular adaptive responses. Therefore, the purpose of the present work was to use a human systemic arterial system model to test the hypothesis that pulse pressure homeostasis can emerge from physiological adaptation of systemic arteries to local mechanical stresses. First, we assumed a systemic arterial system that had a realistic topology consisting of 121 arterial segments. Then the relationships of pulsatile blood pressures and flows in arterial segments were characterized by standard pulse transmission equations. Finally, each arterial segment was assumed to remodel to local stresses following three simple rules: 1) increases in endothelial shear stress increases radius, 2) increases in wall circumferential stress increases wall thickness, and 3) increases in wall circumferential stress decreases wall stiffness. Simulation of adaptation by iteratively calculating pulsatile hemodynamics, mechanical stresses, and vascular remodeling led to a general behavior in response to mechanical perturbations: initial increases in pulse pressure led to increased arterial compliances, and decreases in pulse pressure led to decreased compliances. Consequently, vascular adaptation returned pulse pressures back toward baseline conditions. This behavior manifested when modeling physiological adaptive responses to changes in cardiac output, changes in peripheral resistances, and changes in local arterial radii. The present work, thus, revealed that pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses. vascular adaptation; compliance resetting; pulsatile hemodynamics; multiscale modeling AORTIC PULSE PRESSURE APPEARS to be homeostatic despite the lack of global regulatory mechanisms affecting elastic arteries. Cardiac output, peripheral resistances, and arterial compliances are the primary mechanical determinants of aortic pressures (40,47). Whereas mean pressure is predominantly determined by cardiac output and peripheral resistance, pulse pressure (systolic-diastolic) is also affected by compliance (the change in volume per change in transmural pressure) of the large elastic arteries (69). As arterial compliances decrease, pulse pressures tend to increase (40,41,47,48). Acutely, mean pressure and pulse pressure are physiologically coupled by feedback mechanisms: when pulse pressure rises, stretch-sensitive baroreceptors lower peripheral resistance, i.e., the baroreflex, which, in turn, lowers mean pressure. Furthe...

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Section: Judicious Use Of Simplifying Assumptions Allowed Identificatsupporting

confidence: 59%

Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses

Nguyen

Tüzün²,

Quick

2016

American Journal of Physiology-Regulatory, Integrative and Comp

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“…Because strain in longitudinal direction is the most widely used type of strain and is a robust index for clinical studies [ 10 ], we have chosen to focus on longitudinal strain. One study recently described a significant lower LV global longitudinal strain (GLS) after CoA repair in a small cohort of heterogeneous patients including children and adults [ 11 ]. Our group of CoA subjects, age- and sex-matched, is the largest and oldest in which LV GLS has been studied to date.…”

Section: Introductionmentioning

confidence: 99%

Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation

Menting

Grootel

Bosch

et al. 2016

Int J Cardiovasc Imaging

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Despite successful aortic coarctation (CoA) repair, systemic hypertension often recurs which may influence left ventricular (LV) function. We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in adults with repaired CoA, and to identify associations with patient and echocardiographic characteristics. In this cross-sectional study, patients with repaired CoA and healthy controls were recruited prospectively. All subjects underwent echocardiography, ECG and blood sampling within 1 day. With speckle-tracking echocardiography, we assessed LV GLS on the apical four-, three- and two-chamber views. We included 150 subjects: 75 patients (57 % male, age 33.4 ± 12.8 years, age at repair 2.5 [IQR: 0.1–11.1] years) and 75 healthy controls of similar sex and age. LV GLS was lower in patients than in controls (−17.1 ± 2.3 vs. −20.2 ± 1.6 %, P < 0.001). Eighty percent of the patients had a normal LV ejection fraction, but GLS was still lower than in controls (P < 0.001). In patients, GLS correlated with systolic and diastolic blood pressure (r = 0.32, P = 0.009; r = 0.31, P = 0.009), QRS duration (r = 0.34, P = 0.005), left atrial dimension (r = 0.27, P = 0.029), LV mass (r = 0.30, P = 0.014) and LV ejection fraction (r = −0.48, P < 0.001). Patients with either associated cardiac lesions, multiple cardiac interventions or aortic valve replacement had lower GLS than patients without. Although the majority of adults with repaired CoA seem to have a normal systolic LV function, LV GLS was decreased. Higher blood pressure, associated cardiac lesions, and larger left atrial dimension are related with lower GLS. Therefore, LV GLS may be used as objective criterion for early detection of ventricular dysfunction.Electronic supplementary materialThe online version of this article (doi:10.1007/s10554-016-0838-8) contains supplementary material, which is available to authorized users.

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“…Previous studies drawing on color‐coded tissue Doppler echocardiography in patients with ASDs evaluated the atrial functions only in a single segment of the atrial walls . Two‐dimensional speckle‐tracking echocardiography has been used for the evaluation of the atrial functions in some congenital heart diseases such as pulmonary atresia, ASDs, coarctation of the aorta, and tetralogy of Fallot . There is a dearth of data in the current literature on the comparison of the atrial functions between surgical and percutaneous device ASD closure at follow‐up durations of longer than 1 year.…”

mentioning

confidence: 99%

“…7,10 Two-dimensional speckle-tracking echocardiography has been used for the evaluation of the atrial functions in some congenital heart diseases such as pulmonary atresia, ASDs, coarctation of the aorta, and tetralogy of Fallot. 6,[14][15][16] There is a dearth of data in the current literature on the comparison of the atrial functions between surgical and percutaneous device ASD closure at follow-up durations of longer than 1 year. On the basis of our hypothesis that the functions of the RA and LA are at normal levels between 1 and 5 years after corrective procedures, we used 2D speckle-tracking echocardiography for the evaluation of the RA and LA functions in patients who underwent surgical or device ASD closure and a control group for longer than 1 year after the procedure.…”

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confidence: 99%

Assessment of the Right and Left Atrial Functions at Midterm After Surgical and Device Atrial Septal Defect Closure: A 2‐Dimensional Speckle‐Tracking Echocardiographic Study

Haji-Zeinali

Iri

Hosseinsabet

2018

J of Ultrasound Medicine

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Objectives The available literature lacks data on the comparison of the functions of the right atrium (RA) and left atrium (LA) between surgical atrial septal defect (ASD) closure and percutaneous device ASD closure at follow‐up durations of longer than 1 year. We sought to evaluate the RA and LA functions in patients who underwent surgical or device ASD closure between 1 and 5 years postprocedurally. Methods The study population included 30 patients who underwent device ASD closure and 30 who underwent surgical ASD closure, who were matched for the procedural time, age, and sex, in addition to 30 control participants. The RA and LA functions were evaluated with 2‐dimensional speckle‐tracking echocardiography. Results The LA systolic and early diastolic strain and strain rate values and the RA early diastolic strain rate in the device closure group were more likely to be abnormal than in the control group. The RA systolic and late diastolic strain and strain rate values, the RA early diastolic strain rate, and the LA early diastolic strain in the surgical closure group were more likely to be abnormal than in the control group. The RA systolic strain and strain rate in the surgical closure group were more likely to be abnormal than in the device closure group. Conclusions The LA reservoir and conduit functions and the RA contraction function in the patients who underwent device ASD closure and all of the RA functions and the LA conduit function in the patients who underwent surgical ASD closure were more likely to be abnormal than those in the control participants. The RA reservoir function in the surgical closure group was more likely to be abnormal than that in the device closure group.

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Arterial-left ventricular-left atrial coupling late after repair of aortic coarctation and interruption

Abstract: Our findings suggest impairment of arterial function and LV and LA mechanics in patients after CoA and IAA repair and implicate an abnormal arterial-LV-LA interaction.

Cited by 18 publications

References 46 publications

Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses

Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses

Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation

Assessment of the Right and Left Atrial Functions at Midterm After Surgical and Device Atrial Septal Defect Closure: A 2‐Dimensional Speckle‐Tracking Echocardiographic Study

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