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Beyond Pressure Gradients: The Effects of Intervention on Heart Power in Aortic Coarctation

Joao Filipe Fernandes1, Leonid Goubergrits1,2, Jan Brüning2

  • 1Department of Congenital Heart Disease, German Heart Centre Berlin, Augustenburger Platz 1, Berlin, Germany.

Plos One
|January 13, 2017
PubMed

Insights

Interventional treatment for aortic coarctation significantly reduced internal heart power (IHP) and improved cardiac efficiency, particularly in patients with high baseline IHP. Pressure gradients did not correlate with these improvements.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Current guidelines for aortic coarctation focus on pressure gradients.
  • Physiologically, reducing pressure gradients should improve cardiac energy expenditure and prevent organ damage.

Purpose of the Study:

  • To assess the impact of interventional treatment on external and internal heart power (EHP, IHP) in aortic coarctation patients.
  • To explore the correlation between EHP, IHP, and pressure gradients from heart catheterization.

Main Methods:

  • 52 patients with aortic coarctation underwent intervention (stenting/angioplasty) or MRI before and after treatment.
  • External and internal heart power (EHP, IHP) were calculated using catheterization and MRI data.
  • A cardiac energy profile, including power efficiency, was created.

Main Results:

  • Intervention significantly reduced catheter gradient (21.8 to 6.2 mmHg) and IHP (8.03 to 4.37 W).
  • EHP showed a minor reduction (1.1 to 1.0 W).
  • Patients with high baseline IHP (>5W) showed significant IHP reduction and increased power efficiency (14% to 26%); those with low baseline IHP (<5W) showed no significant changes.

Conclusions:

  • Interventional treatment decreases IHP in aortic coarctation.
  • Pressure gradients lack correlation with changes in EHP or IHP, questioning their primary focus in interventions.
  • Improvements in IHP and power efficiency were observed only in patients with high baseline IHP.
Abstract

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