Myocardial strain pattern progress in patients with Coarctation of the Aorta undergoing aortic stenting

Abstract

Background and Aim Ventricular function evaluation in coarctation of the aorta (CoA) has become more sophisticated and precise with speckle tracking, revealing subclinical changes. However, CoA stenting treatment effects in on myocardial strain are still controversial. This study aimed to estimate the extent to which changes in left ventricular global longitudinal strain (LV GLS) occur in patients with CoA who undergo stenting. Methods The study included 21 patients with CoA (median age: 15 years [8–39]) and 21 healthy individuals matched by age and gender. Clinical and echocardiographic evaluations were performed 1 day before, 6 months, and 1 year after stenting. Correlations between LV GLS and arm‐leg gradient, isthmus gradient on echocardiogram, age at intervention, left ventricular mass, and ejection fraction were tested. Results Before treatment, patients with CoA had lower LV GLS than the control group (−18.4% ± 1.96 vs −21.5% ± 1.37; P < .01), showing significant increase to −19.4% ± 2.1 at 6 months and −20.7% ± 2.19 at 1 year, P < .001. Only 28.5% (6 patients) had preserved GLS before treatment, improving to 80.9% (17 patients) in 1 year. The only variable correlated with low LV GLS values before treatment was age at intervention (Spearman's index = −0.571; P = .007). Conclusion Percutaneous therapy showed significant LV GLS improvement 12 months after aortic stenting. Older patients have lower GLS, suggesting that early intervention may have positive effects on preservation of LV systolic function.

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

“…As demonstrated by Aragao et al, 1 LV‐GLS was below the normal values in 71.5% of patients, despite asymptomatic. Probably, the improving in LV‐GLS in a large part of these patients (81%) was due to a reverse remodeling of the fibers once the afterload and the left ventricular wall stress decreased after the relief of the gradient 10 .…”

“…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.…”

Beyond the Short-Term in Neonatal Coarctation

“…In addition, LV strain abnormalities associated with coarctation can improve over time, even in older patients who had catheter based or surgical repair. 5 …”