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Updated: Jun 10, 2026
Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents
Published on: July 14, 2021
Heart rate and left ventricular remodeling after repaired coarctation of the aorta: a cross-sectional study
Marina Vaccari1, Laura E Maldonado1, Claudio G Moros2
1Consultorio de Hipertensión Arterial, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina.
Insights
Patients with repaired coarctation of the aorta (CoAo) may experience left ventricular hypertrophy (LVH) due to factors beyond blood pressure. Lower heart rate is linked to increased ventricular mass, suggesting a potential therapeutic target.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Research
Background:
- Repaired coarctation of the aorta (CoAo) patients face risks of left ventricular hypertrophy (LVH) independent of hypertension.
- Wave reflection alterations may influence ventricular remodeling beyond direct pressure load.
Purpose of the Study:
- To investigate the relationship between central hemodynamics, heart rate, and left ventricular structure in patients with repaired CoAo.
- To explore potential mechanistic links between wave reflection timing and ventricular remodeling.
Main Methods:
- Cross-sectional analysis of 57 patients with repaired CoAo.
- Assessment of office and ambulatory blood pressure, central hemodynamics, and echocardiographic indices.
- Regression models and computational simulations to evaluate associations with posterior wall thickness and the impact of heart rate.
Main Results:
- LVH prevalence was 15.2% despite normal central blood pressure in most patients.
- Heart rate-adjusted augmentation index (AIX@75) was inversely associated with posterior wall thickness in diastole (PWTd).
- Lower heart rate independently associated with greater PWTd; simulations showed increased heart rate reduced PWTd and hypertrophy prevalence.
Conclusions:
- Ventricular remodeling occurs in repaired CoAo patients even with normal central blood pressure.
- A lower heart rate is associated with increased left ventricular mass.
- Heart rate's modulation of wave reflection timing is a potential therapeutic target for managing ventricular remodeling.
Background:
Patients with repaired coarctation of the aorta (CoAo) remain at risk for left ventricular hypertrophy (LVH) even in the absence of hypertension. Alterations in wave reflection and the timing of reflected pressure waves may contribute to ventricular remodeling beyond pressure load alone.
Methods:
We performed a cross-sectional analysis of patients with repaired CoAo. Office and ambulatory blood pressure (ABPM), non-invasive central hemodynamics, and echocardiographic indices of left ventricular structure were assessed. Linear and multivariable regression models evaluated associations with posterior wall thickness in diastole (PWTd) and interventricular septal thickness in diastole. Computational simulations were conducted to examine the impact of heart rate on ventricular remodeling.
Results:
Fifty-seven patients (median post-repair follow-up 11 years) were included. LVH prevalence was 15.2% (95% confidence interval [CI], 4.8, 25.6). Although 42% met criteria for hypertension based on ABPM, no patients exhibited elevated central blood pressure and LVH. Heart rate-adjusted augmentation index (AIX@75) was inversely associated with PWTd and remained independently associated after multivariable adjustment (R2 = 0.40, P < 0.01). Replacing AIX@75 by heart rate improved model performance (R2 = 0.44), with lower heart rate independently associated with greater PWTd. Simulation modeling showed that a 10% increase in heart rate reduced mean PWTd and decreased posterior wall hypertrophy prevalence from 30.9% to 2.4% (odds ratio, 0.10; 95% CI, 0.01, 0.44).
Conclusions:
Ventricular remodeling occurs despite normal central blood pressure in CoAo. A lower heart rate associates with increased ventricular mass. Heart rate-mediated modulation of wave reflection timing represents a potential mechanistic and therapeutic target.
