Persistent hypertension and left ventricular remodeling after stenting for coarctation of the aorta: a single-center...

Persistent hypertension (HTN) remains common after covered stent implantation for coarctation of the aorta (CoA). However, existing evidence is derived predominantly from surgical repair cohorts and cross-sectional echocardiography, leaving the individual trajectory of left ventricular (LV) remodeling after stenting poorly defined. We retrospectively studied 84 patients with complete persistent HTN status, and 75 patients with paired follow-up echocardiography for LV remodeling analyses. Multivariable logistic and linear regression were performed to identify factors associated with persistent HTN and follow-up LV mass index (LVMI) separately. Paired changes in LV hypertrophy (LVH) and LV geometry were assessed using McNemar and Stuart-Maxwell tests. Persistent HTN occurred in 46 of 84 patients (54.8%) at a median clinical follow-up of 9 years, and was associated with older age at repair and higher preoperative systolic blood pressure. Higher follow-up LVMI was associated with higher baseline LVMI, male sex and longer follow-up duration. At a median echocardiographic follow-up of 2 years, LVH prevalence decreased from 41.3-24.0%. This net decline masked bidirectional individual trajectories: 19 of 31 patients with baseline LVH (61.3%) no longer met LVH criteria, whereas 6 of 44 patients without baseline LVH (13.6%) developed new-onset LVH. Anatomical relief after CoA stenting therefore does not preclude ongoing myocardial burden, and patients developing new-onset LVH would not be identified by preoperative risk stratification alone. Serial echocardiographic assessment should complement long-term blood pressure surveillance, though these findings require validation in larger cohorts with standardized follow-up.