Aortic stiffening and its impact on left atrial volumes and function in patients after successful coarctation repair: a multiparametric cardiovascular magnetic resonance study

Abstract

BackgroundThe increased cardiovascular morbidity of adults with late repair of aortic coarctation (CoA) has been well documented. In contrast, successful CoA repair in early childhood has a generally good prognosis, though adverse vascular and ventricular characteristics may be abnormal, which could increase long-term risk. This study sought to perform a comprehensive analysis of aortic elasticity and left ventricular (LV) function in patients with aortic coarctation (CoA) using cardiovascular magnetic resonance (CMR). In a subgroup of patients, we assessed structure and function of the common carotid arteries to probe for signs of systemic vascular remodeling.MethodsFifty-one patients (median age 17.3 years), 13.9 ± 7.5 years after CoA repair, and 54 controls (median age 19.8 years) underwent CMR.We determined distensibility and pulse wave velocity (PWV) at different aortic locations. In a subgroup, common carotid artery distensibility, PWV, wall thickness and wall area were measured. LV ejection fraction (EF), volumes, and mass were measured from short axis views. Left atrial (LA) volumes and functional parameters (LAEFPassive, LAEFContractile, LAEFReservoir) were assessed from axial cine images.ResultsIn patients distensibility of the whole thoracic aorta was reduced (p < 0.05) while PWV was only significantly higher in the aortic arch (p < 0.01). Distensibility of the descending aorta at the level of the pulmonary arteries and PWV in the descending aorta, both correlated negatively with age at CoA repair. LA volume before atrial contraction and minimal LA volume were higher in patients (p < 0.05). LAEFPassive and LAEFReservoir were reduced (p < 0.05), and LAEFReservoir correlated negatively with aortic arch PWV (p < 0.05). LVEF, volumes and mass were not different from controls. Carotid wall thickness and PWV were higher in patients compared to controls (p < 0.05).ConclusionsPatients after CoA repair have impaired bioelastic properties of the thoracic aorta with impact on LV diastolic function. Reduced descending aortic elasticity is associated with older age at time of CoA repair. The remodeling of the common carotid artery in our sub-study suggests systemic vessel wall changes.

Stroke in Adults With Coarctation of the Aorta: A National Population‐Based Study

“…There are multiple proposed contributors to the early age of stroke in patients with CoA. Long‐term vascular dysfunction and increased carotid intima‐medial thickness may increase the risk of ischemic stroke . In addition, CoA patients are more likely to be male and have hyperlipidemia .…”

“…Long-term vascular dysfunction and increased carotid intima-medial thickness may increase the risk of ischemic stroke. 13,[34][35][36][37] In addition, CoA patients are more likely to be male and have hyperlipidemia. 38,39 There is a high prevalence (10%-12%) of intracranial aneurysms, which may predispose to hemorrhagic stroke.…”

Is the burden of late hypertension and cardiovascular target organ damage in children and adolescents with coarctation of the aorta after early successful repair different to healthy controls?

“…20,38 Most of the studies, evaluating pulse wave velocity in patients with coarctation of the aorta, have a heterogenous study population in terms of age including both adults and paediatric age groups. 9,27,[39][40][41] The studies which include only children and adolescents are scarce. 5,42 In general, these studies have shown increased pulse wave velocity (m/s) in the precoarctation aorta after successful repair of the coarctation compared to controls.…”

Long-term outcomes after aortic coarctation repair in Maltese patients: A population-based study

“…In the absence of significant recoarctation, medical treatment of HT in this setting often follows the same algorithms applied for essential HT . An increase in left ventricular (LV) mass has been observed in several patients even in the absence of HT and is thought to be related to central aortic stiffness . This can in turn result in diastolic dysfunction and increase the risk of subendocardial ischemia and arrhythmias .…”

“…23 An increase in left ventricular (LV) mass has been observed in several patients even in the absence of HT and is thought to be related to central aortic stiffness. [24][25][26] This can in turn result in diastolic dysfunction and increase the risk of subendocardial ischemia and arrhythmias. 2 While CAD is a main contributor of increased mortality among repaired CoA patients, it is still uncertain whether there is an independent association between the two 27,28…”