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Reverse Cardiac Remodeling Induced by Endovascular Treatment of Coarctation of the Aorta
Melody Farrashi1,2, Shirin Habibi Khorasani2, Ahmadreza Tanbakookar1,3
1Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Institute, Tehran, Iran.
Insights
Stent coarctoplasty significantly improved heart function and reduced left ventricular mass in adults with coarctation of the aorta. These positive changes in echocardiographic parameters were sustained at 3-year follow-up.
Area of Science:
- Cardiology
- Interventional Cardiology
- Echocardiography
Background:
- Limited research exists on echocardiographic changes after coarctation of the aorta (CoA) stenting.
- This study evaluates mid- to long-term echocardiographic parameter changes post-stent coarctoplasty.
Purpose of the Study:
- To assess mid-term echocardiographic parameter transformations in patients with native coarctation of the aorta (CoA) after stent coarctoplasty.
- To compare baseline and 3-year transthoracic echocardiographic (TTE) data.
Main Methods:
- Substudy of a randomized clinical trial comparing balloon-expandable versus self-expandable stents for native CoA.
- Analysis of baseline and 3-year core laboratory-confirmed TTE data from 32 participants.
Main Results:
- Significant improvements in diastolic function (increased septal/lateral E', decreased E/E' ratios) at 3 years.
- Significant reduction in left ventricular (LV) mass (p=0.001), with 75% of patients with baseline LV hypertrophy normalizing.
- Decreased prevalence of diastolic dysfunction from 41.3% to 13.7% at 3-year follow-up.
Conclusions:
- Stent coarctoplasty leads to significant and sustained improvements in LV diastolic function and reduced LV mass in adults with de novo native CoA.
- Baseline structural parameters appear to be stronger predictors of long-term outcomes than demographic factors.
Background:
Limited research has explored the transformation of echocardiographic parameters during mid- to long-term follow-up in patients with native coarctation of the aorta (CoA) managed through stenting. This study assesses changes in echocardiographic parameters among patients undergoing stent coarctoplasty, by comparing baseline and 3-year transthoracic echocardiographic (TTE) parameters.
Methods:
In our earlier work, we detailed the 3-year clinical safety and efficacy outcomes of balloon-expandable versus self-expandable stents for treating native CoA within a randomized clinical trial. The current substudy aims to assess the mid-term effects of stenting by examining all participants with available baseline and 3-year core laboratory-confirmed TTE data.
Results:
Of the 92 patients enrolled in the randomized trial, 32 individuals (median age: 32 years [IQR: 24.8-37.5]) were included in this substudy. At the 3-year follow-up, significant improvements were observed in myocardial diastolic function, characterized by increased septal E' and lateral E' velocities (p = 0.02 and p = 0.03, respectively) and decreased septal and lateral E/E' ratios (10.84 ± 2.83 to 9.21 ± 3.17, p = 0.02 and 7.39 ± 2.24 to 6.29 ± 1.97, p = 0.02, respectively). At the 3-year follow-up, a significant reduction in left ventricular (LV) mass was observed, decreasing from 160 g (IQR: 130-203) to 142 g (IQR: 121-172) (p = 0.001). Among the 12 patients (37.5%) presenting with baseline LV hypertrophy, nine individuals (75%) experienced normalization, demonstrating a substantial improvement in LV mass. Additionally, the prevalence of diastolic dysfunction significantly decreased from 12 patients (41.3%) to four patients (13.7%) at the 3-year evaluation.
Conclusions:
In adult patients with de novo native CoA, stent coarctoplasty was found to result in significant and sustained improvements in LV diastolic function and reduced LV mass during the mid-term follow-up. Our findings imply that baseline structural parameters may serve as stronger predictors of long-term therapeutic outcomes than demographic factors.
Trail Registration:
Iranian Registry of Clinical Trials: IRCT20181022041406N3.
