Mechanical deformation in adult patients with unrepaired aortic coarctation

Abstract

Aortic coarctation is a congenital heart disease that causes an increased left ventricular afterload, resulting in increased systolic parietal tension, compensatory hypertrophy, and left ventricular systolic and diastolic dysfunction. The speckle tracking is a new echocardiographic technique that allows the detection of subclinic left ventricular systolic dysfunction. The aim of this study was to detect early left ventricular dysfunction using mechanical deformation by echocardiography in adults with un-repaired aortic coarctation. A total of 41 subjects were studied, 20 patients with aortic coarctation and 21 control subjects, 21 women (51.2%), with an average age of 30 ± 10 years. All patients with aortic coarctation had systemic arterial hypertension (p < 0.001). Seventy percent (14/20) of the patients had bicuspid aortic valve. Statistically significance (p < 0.005) were found in left ventricular mass index, E/e ratio, pulmonary artery systolic pressure and peak velocity and maximum gradient of the aortic valve. The global longitudinal deformation of the left ventricle in patients with aortic coarctation was significative decreased, p < 0.001. The ejection fraction and the global longitudinal deformation of the left ventricle were significantly lower in patients with aortic coarctation compared to the control group, p < 0.003, p < 0.001, respectively. The subgroup of patients with coarctation and left ventricular ejection fraction < 55% had a marked decrease in global longitudinal strain (- 15.9 ± 4%). The radial deformation was increased in patients with aortic coarctation and showed a trend to be significant (r = 0.421; p < 0.06). A significant negative correlation was observed between the global longitudinal deformation and left ventricular mass index (r = 0.54; p = 0.01) in the aortic coarctation group. The patients with aortic coarctation and left ventricular hypertrophy had marked reduction of left ventricular global longitudinal deformation (- 16%, p < 0.05). In our study patients with normal left ventricular ejection fraction had abnormal global longitudinal deformation and also the increased left ventricular mass was related with a decreased left ventricular global longitudinal deformation as a sign of subclinical systolic dysfunction.

The mechanics of congenital heart disease: from a morphological trait to the functional echocardiographic evaluation

“…Avendaño-Pérez et al showed that adult patients with unrerpaied CoA had LVH, an increased LV mass, lower values of LV EF and GLS compared to controls, and that values of myocardial deformation were inversely related to LV mass. Also, GLS was reduced in patients with preserved EF, confirming the ability of this technique in detecting subclinical dysfunction ( 20 ).…”

“…Avendaño-Pérez et al showed that adult patients with unrerpaied CoA had LVH, an increased LV mass, lower values of LV EF and GLS compared to controls, and that values of myocardial deformation were inversely related to LV mass. Also, GLS was reduced in patients with preserved EF, confirming the ability of this technique in detecting subclinical dysfunction (20). Indeed, regional longitudinal systolic myocardial deformations as assessed by strain rate (SR) were significantly reduced in a large sample of young normotensive patients years after successful CoA repair in the presence of a normal/increased LVEF.…”

LV‐GLS in congenital heart disease, time to go beyond ejection fraction

“…In this paper, Aragao et al 1 showed a reduced left ventricular global longitudinal strain (LV‐GLS) before aortic coarctation repair and a progressive improvement after aortic coarctation stenting, despite the left ventricular ejection fraction remained unchanged over the time. Previous studies documented a decreased LV‐GLS in aortic coarctation, either before 2 and after 3,4 repair, showing that the ejection fraction in these patients is normal despite the presence of aortic coarctation, persisting arterial hypertension, or mild aortic valve disease. However, the life expectancy of these patients is reduced compared to healthy subjects.…”

Autopsy in adults with congenital heart disease (ACHD)

“…It usually occurs near the ductus/ligamentum arteriosum, in a para-, pre-or postductal location, causing a discrete aortic lumen narrowing or a hypoplastic segment of the aorta [22,39,40] (Fig. 6a).…”