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Pulsatility index in aortic coarctation: a possible way to evaluate factors affecting stenting outcome
Shokoufeh Hajsadeghi1, Seyed-Mohammad Fereshtehnejad, Saeid Gholami
1Rasoul-e-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Pulsatility index (PI) significantly increased after aortic coarctation stenting. Baseline echocardiographic indices like D/S velocity ratio predicted this PI elevation, aiding in treatment assessment.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Pulsatility index (PI) reflects end-organ blood flow and is typically reduced in aortic coarctation.
- Restoration of normal blood flow is crucial post-aortic coarctation repair.
- Limited data exist on PI trends after aortic stenting and its correlation with echocardiographic findings.
Purpose of the Study:
- To evaluate changes in PI following aortic stent implantation.
- To assess the correlation between post-stenting PI and baseline echocardiographic indices.
Main Methods:
- Twenty-three patients with aortic coarctation underwent pre- and post-stenting echocardiography.
- Patients were grouped by PI increase (<50% vs. ≥50%) post-stenting.
- Correlation analysis between baseline echocardiographic parameters and PI changes was performed.
Main Results:
- PI significantly increased post-stenting (0.89 to 1.75, p<0.001).
- Higher baseline abdominal aorta D/S velocity ratio, mean velocity, and descending aorta peak gradient were observed in patients with ≥50% PI increase.
- Baseline systolic blood pressure was also a significant predictor.
Conclusions:
- Elevated PI post-stenting is a predictable outcome in aortic coarctation patients.
- Baseline echocardiographic indices, including D/S velocity ratio, mean velocity, and peak gradient, predict significant PI increase after stenting.
- These findings offer insights into post-procedural flow dynamics and patient stratification.
Background:
The pulsatility index (PI) shows continuous blood flow to the end organs and is a significant factor believed to decrease in aortic coarctation. Correction of this factor is of great importance in the treatment of stenotic lesions of the aorta. However, there are minimal data regarding the trend of changes in the PI after stent implantation. Furthermore, the association between the PI and other echocardiographic indices in patients undergoing stent implantation is unclear. This study was designed to evaluate changes in the PI following stenting and its correlation with other echocardiographic indices.
Methods:
Twenty-three patients with a diagnosis of aortic coarctation consecutively underwent two-dimensional and Doppler echocardiographic imaging modalities twice (before and after stenting). The patients were divided into two groups based on the percentage of increase in the PI after stenting (< 50% or ≥ 50%). The relation between the post-stenting PI and the baseline echocardiographic indices was assessed.
Results:
The PI was increased from 0.89 (SD = 0.30) to 1.75 (SD = 0.51) after stenting (p value < 0.001). Baseline diastolic/systolic velocity (D/S velocity) ratio of the abdominal aorta (p value = 0.013), mean velocity (p value = 0.033), and peak gradient of the descending aorta (p value = 0.033) were significantly higher in the patients with ≥ 50% increase in the PI after stenting.
Conclusion:
OUR FINDINGS SHOWED THAT ELEVATION IN THE PI AFTER STENTING WAS A PREDICTABLE CRITERION IN PATIENTS WITH AORTIC COARCTATION: it was predicted by some baseline clinical and echocardiographic indices. Baseline D/S ratio velocity of the abdominal aorta, mean velocity and peak gradient of the descending aorta, and baseline systolic blood pressure were the statistically significant indices to predict ≥ 50% increase in the PI in our patients.
