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Determinants of Left Ventricular Diastolic Function and Exertional Symptoms in Adults With Coarctation of Aorta
Alexander C Egbe1, Muhammad Y Qureshi2, Heidi M Connolly1
1Department of Cardiovascular Medicine (A.C.E., H.M.C.), Mayo Clinic, Rochester, MN.
Insights
The aortic isthmus ratio is the strongest indicator of left ventricular diastolic dysfunction and exercise symptoms in coarctation of the aorta (COA). This finding may simplify patient selection for COA intervention and improve long-term outcomes.
Area of Science:
- Cardiology
- Medical Diagnostics
- Clinical Research
Background:
- Coarctation of the aorta (COA) causes chronic left ventricular (LV) pressure overload, leading to diastolic dysfunction and heart failure.
- Current COA intervention timing relies on various severity indices, but their link to LV diastolic dysfunction and exertional symptoms is unclear.
Purpose of the Study:
- To evaluate the association between coarctation of aorta (COA) severity indices and left ventricular (LV) diastolic function and exertional symptoms.
Main Methods:
- A cross-sectional study involving 546 adult COA patients.
- Multivariate linear and logistic regression analyses were used to assess correlations.
Main Results:
- The aortic isthmus ratio showed the strongest correlation with LV diastolic function (e' and E/e') and exertional symptoms (peak oxygen consumption and NYHA class).
- Specific correlations were detailed for the aortic isthmus ratio with e', E/e', peak oxygen consumption, and NYHA II-IV symptoms.
Conclusions:
- The aortic isthmus ratio is the most significant index for assessing LV diastolic function and exertional symptoms in COA patients.
- This finding could refine patient selection for COA intervention, potentially improving long-term outcomes by addressing diastolic dysfunction earlier.
Background:
Coarctation of aorta (COA) results in chronic left ventricular (LV) pressure overload and subsequently leads to LV diastolic dysfunction and heart failure over time. The goal of COA intervention is to prevent these complications. The timing of COA interventions is based on the presence of these COA severity indices: doppler mean COA gradient, systolic blood pressure, upper-to-lower-extremity SBP gradient, aortic isthmus ratio, presence of collaterals, and exercise-induced hypertension. Although these indices are physiologically intuitive, the relationship between these indices and LV diastolic dysfunction and exertional symptoms has not been studied. The purpose of this study was to evaluate the association between the indices of COA severity and LV diastolic function and symptoms.
Methods:
In this cross-sectional study, multivariate linear and logistic regression analyses were used to assess the correlation between indices of COA severity, LV diastolic function (average e' and E/e'), and exertional symptoms (NYHA II-IV and peak oxygen consumption).
Results:
Of all the COA indices analyzed in 546 adult COA patients, aortic isthmus ratio had the strongest correlation with e' (β [95% CI]: 3.11 [2.02-4.31]; P=0.014) per 1 cm/second; E/e' (-13.4 [-22.3 to -4.81]; P=0.009) per 1 unit; peak oxygen consumption (4.05 [1.97-6.59] per 1% change, P=0.019), and NYHA II to IV symptoms (odds ratio, 2.16 [1.65-3.18]; P=0.006).
Conclusions:
Of all the COA severity indices stipulated in the guidelines, aortic isthmus ratio had the strongest correlation with LV diastolic function and exertional symptoms. As LV diastolic dysfunction typically precede heart failure symptoms, we anticipate that the results of this study will improve and simplify patient selection for COA intervention and potentially improve long-term outcomes.