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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
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Prognostic implications of left heart diastolic dysfunction in adults with coarctation of aorta

Alexander C Egbe1, William R Miranda1, Jae K Oh1

  • 1Department of Cardiovascular Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.

European Heart Journal. Cardiovascular Imaging
|August 23, 2021
PubMed

Insights

Left atrial dysfunction, not left ventricular diastolic dysfunction, is linked to increased mortality risk in coarctation of aorta patients. This finding aids in prognostication for all patients, including those with indeterminate diastolic function.

Area of Science:

  • Cardiology
  • Echocardiography
  • Congenital Heart Disease

Background:

  • Coarctation of aorta (COA) is a congenital heart defect with known long-term cardiovascular implications.
  • The prognostic value of left atrial (LA) dysfunction and left ventricular diastolic dysfunction (LVDD) in repaired COA patients remains unclear.

Purpose of the Study:

  • To investigate the association between LA dysfunction, LVDD, and mortality in adult patients with repaired COA.

Main Methods:

  • Retrospective review of 721 adult patients with repaired COA who underwent echocardiography between 2000-2018.
  • LVDD assessed using 2016 guidelines; LA dysfunction evaluated by LA reservoir strain.
  • Patients categorized by LVDD grade and LA strain quartiles.

Main Results:

  • Grade III LVDD was associated with increased risk of death/transplant.
  • An incremental increase in mortality risk was observed across LA strain quartiles, with severe LA dysfunction showing the highest risk (HR 3.49).
  • A trend towards lower 5-year transplant-free survival was noted in patients with LA dysfunction among those with indeterminate diastolic function.

Conclusions:

  • Left atrial dysfunction, assessed by LA reservoir strain, is an independent predictor of mortality in patients with repaired COA.
  • Left ventricular diastolic dysfunction (LVDD) grade III is also associated with adverse outcomes.
  • LA dysfunction can be utilized for prognostication in all COA patients, including those with indeterminate diastolic function.
Abstract

Keywords:
coarctation of aortaleft atrial dysfunctionleft ventricular diastolic dysfunction

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