Factors affecting left ventricular remodelling and mechanics in the long-term follow-up after successful repair of aortic coarctation

Crepaz, R; Cemin, Roberto; Romeo, Cristina; Bonsante, Edoardo; Gentili, Lino; Trevisan, D.; W, Pitscheider; Stellin, Giovanni

doi:10.1017/s104795110500034x

Cited by 17 publications

(19 citation statements)

References 37 publications

(41 reference statements)

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“…However, it is worth noting that Corrected rabbits collectively had almost the same LV EF as CoA rabbits, with an LV mass similar to those in Control rabbits. These differences did not reach significance with the sample size of the current investigation, but may be hypothesis generating in terms of an acceptable BPG for the LV given other research from corrected CoA in a persistent hyperdynamic state(4, 5). …”

Section: Discussioncontrasting

confidence: 65%

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Treating a 20 mm Hg gradient alleviates myocardial hypertrophy in experimental aortic coarctation

Wendell

Friehs

Samyn

et al. 2017

Journal of Surgical Research

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Background Children with coarctation of the aorta (CoA) can have a hyperdynamic and remodeled left ventricle (LV) from increased afterload. Literature from an experimental model suggests the putative 20 mmHg blood pressure gradient (BPG) treatment guideline frequently implemented in CoA studies may permit irreversible vascular changes. LV remodeling from pressure overload has been studied, but data is limited following correction and using a clinically-representative BPG. Materials and methods Rabbits underwent CoA at 10 weeks to induce a 20 mmHg BPG using permanent or dissolvable suture thereby replicating untreated and corrected CoA, respectively. Cardiac function was evaluated at 32 weeks by magnetic resonance imaging (MRI) using a spoiled cine GRE sequence (TR/TE/FA 8/2.9/20), 14×14 cm FOV and 3 mm slice thickness. Images (20 frames/cycle) were acquired in 6–8 short axis views from the apex to the mitral valve annulus. LV volume, ejection fraction (EF), and mass were quantified. Results LV mass was elevated for CoA (5.2±0.55 g) vs Control (3.6±0.16 g) and Corrected (4.0± 0.44 g) rabbits, resulting in increased LV Mass/Volume ratio for CoA rabbits. A trend toward increased EF and stroke volume was observed, but did not reach significance. Elevated EF by volumetric analysis in CoA rabbits was supported by concomitant increases in total aortic flow by phase-contrast MRI. Conclusions The indices quantified trended towards a persistent hyperdynamic LV despite correction, but differences were not statistically significant versus Control rabbits. These findings suggest the current putative 20 mmHg BPG for treatment may be reasonable from the LV’s perspective.

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Section: Discussioncontrasting

confidence: 65%

“…Many of the long-term problems observed after treatments for CoA can be explained on the basis of abnormal cardiac and vascular biomechanics(3). For example, patients with primary or residual CoA may have a hyperdynamic and remodeled LV, if exposed to a prolonged increase in afterload(4, 5). …”

Section: Introductionmentioning

confidence: 99%

Treating a 20 mm Hg gradient alleviates myocardial hypertrophy in experimental aortic coarctation

Wendell

Friehs

Samyn

et al. 2017

Journal of Surgical Research

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“…Este estudio demuestra que los pacientes con CoAo y HAS tuvieron un aumento del índice de masa ventricular izquierda, el cual tuvo una correlación inversa con la deformación longitudinal global; es decir, que a mayor índice de masa ventricular izquierda, menor deformación longitudinal. En cambio, la deformación radial estuvo aumentada, lo que podría estar relacionado con un estado hiperdinámico del VI, como se ha demostrado en pacientes con CoAo que han sido sometidos a una reparación quirúrgica aparentemente exitosa 22 , aunque otros autores, como Shimizu, et al 23 y Palmon, et al 24 , han demostrado que la hipertrofia crónica del VI se asocia con disfunción contráctil, por lo que la hipercontractilidad miocárdica que se encuentra en los pacientes con CoAo puede ser un arterfacto 25 . Gentles, et al 26 demostraron que el strain rate radial pico es una expresión de la contracción de la fibra de la pared media, y en presencia de poscarga baja tiene un comportamiento similar a la relación entre el estrés endocárdico y la velocidad, mostrando evidencia de un estado hipercontráctil inexplicable en los pacientes con CoAo, como nosotros hemos observado en nuestro estudio.…”

Section: Discussionunclassified

Disfunción ventricular subclínica por Speckle Tracking en pacientes adultos con coartación de aorta

Espínola‐Zavaleta

Rúan-Díaz

Soto

et al. 2019

GMM

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“…It has previously been shown that patients with repaired Coa are at risk of developing increased lV mass due to impairment of vascular mechanics, and abnormal blood pressure regulation 7,8 , especially in those with an angulated aortic arch, which in turn is associated with late hypertension 9 . However, little is known about how other factors interact with blood pressure and lV mass in this particular population.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with left ventricular hypertrophy in adults with surgically repaired coarctation of the aorta

Rinnström¹,

Johansson²

2015

ICFJ

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Introduction: Most patients with repaired coarctation of the aorta (CoA) live normal lives and have good physical performance. However, even after a successful surgical intervention, long-term cardiovascular risks including left ventricular hypertrophy remain. The aim of the study was to identify factors associated with increased left ventricular mass (LVM) in patients with surgically repaired CoA. Methods: Consecutive cardiovascular magnetic resonance investigations in 51 patients with surgically repaired CoA (age 37+/-15 years, age at intervention 9.7 ± 6.8 years, 45% female) were reviewed. LVM was measured and indexed to body surface area. The association between increased LVM index and clinical, anatomic and functional variables was investigated with logistic regression analysis. Results: In this population, 14/51 (27%) patients had a LVM index above normal limits. Factors associated with an increased LVM index in univariate analysis were higher systolic blood pressure (odds ratio (OR) = 1.04, 95 % confidence interval (CI) 1.00-1.08, p = 0.03), descending aortic diameter (OR = 1.48, CI 1.14-1.90, p = 0.003) and more than mild aortic valve disease or previous aortic valve intervention (OR = 15.1, CI 2.50-48.4, p=0.002), but not diastolic blood pressure, diameter of ascending aorta, diameter or ratio of CoA, velocity in descending aorta, smoking or bicuspid aortic valve (p > 0.05 for all). In multivariate analysis, only systolic blood pressure (p = 0.05) and aortic valve disease (p = 0.006) remained significant, yielding R2 = 0.47, p = 0.002 for the model. Conclusion: Increased LVM is a common late finding after surgically repaired CoA. This study showed that LVM was associated with modifiable factors; systolic blood pressure and aortic valve disease. As most patients are young, and increased LVM will eventually affect ventricular function, close attention to blood pressure optimization may be of particular importance in the surgically repaired CoA population.

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Factors affecting left ventricular remodelling and mechanics in the long-term follow-up after successful repair of aortic coarctation

Abstract: Patients who have undergone a seemingly successful surgical repair of aortic coarctation may have persistently abnormal geometry with a hyperdynamic state of the left ventricle. This is more frequent in older patients, and in those with higher diastolic blood pressures.

Cited by 17 publications

References 37 publications

Treating a 20 mm Hg gradient alleviates myocardial hypertrophy in experimental aortic coarctation

Treating a 20 mm Hg gradient alleviates myocardial hypertrophy in experimental aortic coarctation

Disfunción ventricular subclínica por Speckle Tracking en pacientes adultos con coartación de aorta

Factors associated with left ventricular hypertrophy in adults with surgically repaired coarctation of the aorta

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