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Increased prevalence of left ventricular diastolic dysfunction in adults with repaired coarctation of aorta

Alexander C Egbe1, William R Miranda1, Heidi M Connolly1

  • 1The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States.

International Journal of Cardiology. Heart & Vasculature
|May 29, 2020
PubMed

Insights

Patients with coarctation of aorta (COA) often experience left ventricular (LV) diastolic dysfunction, even with mild COA. This dysfunction is linked to increased LV mass, suggesting persistent pressure overload in COA patients.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Medical Diagnostics

Background:

  • Coarctation of aorta (COA) is frequently associated with left ventricular (LV) pressure overload and coronary artery disease.
  • Aortic vasculopathy in COA patients can lead to LV pressure overload, irrespective of the severity of COA.
  • LV diastolic dysfunction is a recognized risk factor in these patients.

Purpose of the Study:

  • To investigate the hypothesis that patients with mild COA exhibit greater LV diastolic dysfunction compared to controls.
  • To compare the prevalence of LV diastolic dysfunction in adults with repaired COA versus those without structural heart disease.

Main Methods:

  • Adult patients with mild COA (Doppler peak velocity < 2.5 m/s) were propensity score matched 1:1 with controls.
  • LV diastolic dysfunction was defined as E/e' > 2 standard deviations above age-specific normative values.
  • Echocardiographic parameters, including E/e' and LV mass index (LVMI), were analyzed.

Main Results:

  • COA patients showed significantly higher septal and lateral E/e' ratios compared to controls (p < 0.001).
  • The prevalence of LV diastolic dysfunction was substantially higher in COA patients across all age groups (<40, 41-60, >60 years).
  • LVMI was identified as the strongest determinant of E/e' (p < 0.001).

Conclusions:

  • LV diastolic dysfunction is prevalent in patients with COA, even in mild cases.
  • The association between diastolic dysfunction and LVMI suggests ongoing LV pressure overload in COA patients.
  • These findings highlight the importance of monitoring LV function in COA survivors.
Abstract

Keywords:
COA, coarctation of aortaCoarctation of aortaE, mitral inflow pulsed wave early velocityLV, Left ventricleLVMI, left ventricular mass indexLeft ventricular diastolic dysfunctionLeft ventricular hypertrophye′, mitral annular tissue Doppler early velocity

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