Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation

Abstract

Despite successful aortic coarctation (CoA) repair, systemic hypertension often recurs which may influence left ventricular (LV) function. We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in adults with repaired CoA, and to identify associations with patient and echocardiographic characteristics. In this cross-sectional study, patients with repaired CoA and healthy controls were recruited prospectively. All subjects underwent echocardiography, ECG and blood sampling within 1 day. With speckle-tracking echocardiography, we assessed LV GLS on the apical four-, three- and two-chamber views. We included 150 subjects: 75 patients (57 % male, age 33.4 ± 12.8 years, age at repair 2.5 [IQR: 0.1–11.1] years) and 75 healthy controls of similar sex and age. LV GLS was lower in patients than in controls (−17.1 ± 2.3 vs. −20.2 ± 1.6 %, P < 0.001). Eighty percent of the patients had a normal LV ejection fraction, but GLS was still lower than in controls (P < 0.001). In patients, GLS correlated with systolic and diastolic blood pressure (r = 0.32, P = 0.009; r = 0.31, P = 0.009), QRS duration (r = 0.34, P = 0.005), left atrial dimension (r = 0.27, P = 0.029), LV mass (r = 0.30, P = 0.014) and LV ejection fraction (r = −0.48, P < 0.001). Patients with either associated cardiac lesions, multiple cardiac interventions or aortic valve replacement had lower GLS than patients without. Although the majority of adults with repaired CoA seem to have a normal systolic LV function, LV GLS was decreased. Higher blood pressure, associated cardiac lesions, and larger left atrial dimension are related with lower GLS. Therefore, LV GLS may be used as objective criterion for early detection of ventricular dysfunction.Electronic supplementary materialThe online version of this article (doi:10.1007/s10554-016-0838-8) contains supplementary material, which is available to authorized users.

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

“…Jashari et al reported more impaired longitudinal strain in CoA patients with LV hypertrophy, as confirmed by other studies [ 9 , 27 , 28 , 31 ]. The myofiber orientation changes throughout the myocardium, with a predominantly longitudinal orientation in the endomyocardium [ 10 , 27 ].…”

“…Delayed repair of CoA may induce a maladaptive response of the LV, resulting in adverse outcome later in life [ 12 ]. Age at the time of repair has therefore been identified as a predictor for impaired longitudinal strain [ 31 ]. In addition, the set point of the renin–angiotensin–aldosterone system is defined in neonatal life [ 32 ].…”

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

“…A possible explanation could be time of exposure to maladaptive fibrosis, myocyte degeneration, and myocyte loss 14 . We did not find any correlations between GLS and the other variables, such as arm‐leg gradient, isthmus gradient, hypertension, 37 or LV mass index 17 …”

“…These data suggest that CoA leads to subclinical LV dysfunction, which is not detectable by conventional echocardiography, with progressive improvement after stenting. Similarly, impaired LV GLS in patients with untreated CoA has also been demonstrated by several authors, employing different technologies including magnetic resonance imaging, tissue Doppler, and 2D and 3D speckle tracking 10,14,17,19,20,35 …”

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

“…Actualmente se conoce que la FEVI es un marcador subóptimo de disfunción ventricular sistóli-ca en etapas incipientes de daño miocárdico. El Speckle Tracking es una técnica sofisticada de ecocardiografía que proporciona una evaluación cuantitativa del movimiento del tejido miocárdico, independientemente del ángulo y la geometría ventricular, que permite detectar la disfunción miocárdica subclínica del VI [10][11][12][13] . El objetivo de este estudio fue buscar la presencia de disfunción sistólica temprana del VI en pacientes adultos con CoAo y HAS comparados con pacientes hipertensos sistémicos sin CoAo y controles sanos, mediante la técnica ecocardiográfica de Speckle Tracking.…”