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Myocardial ischemia in asymptomatic adults with repaired aortic coarctation

Stephen C Cook1, Amy K Ferketich, Subha V Raman

  • 1The Adolescent and Young Adult Congenital Heart Disease Program, Ohio State University, Columbus, OH 43210, United States.

International Journal of Cardiology
|February 12, 2008
PubMed

Insights

Repaired coarctation of the aorta in young adults is linked to impaired myocardial perfusion reserve, even without coronary artery disease. These findings may explain long-term cardiac issues in this population.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Medical Diagnostics

Background:

  • Coarctation of the aorta (CoA) is a congenital heart defect leading to hypertension and reduced survival, even after surgical repair.
  • Coronary artery disease (CAD) accounts for a significant portion of deaths in adults with repaired CoA, but the underlying cause remains unclear.
  • Previous studies lacked prospective data to identify the substrate for cardiac events in repaired CoA patients.

Purpose of the Study:

  • To investigate myocardial perfusion abnormalities in asymptomatic adults with repaired CoA using coronary computed tomography angiography (CTA) and cardiac magnetic resonance (CMR).
  • To determine if perfusion deficits exist in the absence of obstructive coronary artery disease in this population.

Main Methods:

  • Prospective enrollment of 27 repaired CoA patients and 10 matched controls.
  • Coronary CTA and CMR imaging were performed on all participants.
  • Myocardial perfusion reserve index (MPRI) was quantified by assessing myocardial signal enhancement during vasodilator stress and rest.

Main Results:

  • No patients exhibited coronary artery atherosclerosis.
  • Significantly impaired endocardial to epicardial perfusion reserve ratio was observed in repaired CoA patients compared to controls (0.72±0.16 vs. 0.91±0.08, p<0.0001).
  • This perfusion deficit remained significant even after excluding patients with recoarctation (p=0.00013).

Conclusions:

  • Adolescent and young adult patients with repaired coarctation of the aorta demonstrate abnormal myocardial perfusion reserve.
  • These perfusion abnormalities occur independently of coronary artery disease.
  • These novel in vivo findings may elucidate the mechanisms behind late-onset cardiac morbidity in repaired CoA patients.
Abstract

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