Preserved Myocardial Deformation after Successful Coarctation Repair: A CMR Feature-Tracking Study

Abstract

Arterial vasculopathy and residual aortic obstruction can lead to left ventricular (LV) dysfunction in patients with coarctation of the aorta (CoA) related to adverse ventriculo-arterial coupling. This study aimed to investigate potential differences in LV myocardial deformation indices between repaired CoA patients and healthy controls. Twenty-two CoA patients (age 30 ± 10.6 years) after surgical repair (n = 12) or balloon angioplasty (BA) (n = 10) without residual stenosis, between 3 months and 16 years of age with > 10 years follow-up were compared to 22 healthy age- and gender-matched controls (age 30 ± 3.8 years). Cardiac magnetic resonance feature tracking (CMR-FT) was used for LV longitudinal-, circumferential-, and rotational deformation indices. Global systolic LV function was preserved in CoA patients (LV ejection fraction 58 ± 4.8 vs. 60 ± 6.8%, p = 0.56) when compared to controls, with normal LV dimensions and mass (p > 0.05). Twelve CoA patients (55%) were hypertensive, of whom 4 were on anti-hypertensive medication. LV global longitudinal strain was preserved in the four-chamber (− 18 ± 4.4 vs. − 16 ± 4.7%, p = 0.06) and two-chamber (− 22 ± 5.1 vs. − 20 ± 6.0%, p = 0.22) orientations in CoA patients. Global circumferential strain was preserved at basal (− 29 ± 4.1 vs. − 28 ± 4.8%, p = 0.43), mid-ventricular (− 27 ± 4.2 vs. − 25 ± 3.0%, p = 0.09), and apical levels (− 35 ± 7.8 vs. − 32 ± 34.9%, p = 0.32). No differences were found in global torsion (2.4 ± 1.3° vs. 2.0 ± 1.4°/cm, p = 0.28), twist (14 ± 5.8° vs. 12 ± 6.3°, p = 0.34), and recoil rate (− 17 ± 9.7° vs. − 17 ± 7.1°/cm s, p = 0.97). Analysis of intra-observer variability demonstrated good reproducibility for all CMR deformation indices. Global and rotational myocardial deformation indices are preserved in CoA patients long-term after repair without residual stenosis, despite a high incidence of hypertension.

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

“…Our study aimed to assure homogeneity of treatment and to apply a longitudinal study design, also comparing with a control group. The findings showed significant improvement in myocardial strain 12 months after aortic stenting, with similar values between the patient group at one year of follow‐up and healthy subjects, which is in agreement with Kowalski et al, 2009, Kowalik et al, 2016, and Dijkema, 2018 9,18,23 …”

“…5,6 Longitudinal strain has been validated to evaluate myocardial deformation in patients with CoA; circumferential strain and radial strain, on the other hand, have not shown so consistent results. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] However, data provided in the literature are still conflicting regarding the effect of successful CoA treatment on myocardial strain, and they show different results, depending on type of treatment, follow-up period, and strain evaluation technique (cardiac magnetic resonance, tissue Doppler, 2D speckle tracking, or 3D speckle tracking).…”