Left ventricular long axis dysfunction in adults with “corrected” aortic coarctation is related to an older age at intervention and increased aortic stiffness

Abstract

Objectives: This study examined the prevalence of left ventricular (LV) long axis dysfunction (LAD, septal annulus pulsed-wave (PW) tissue Doppler imaging (TDI) early diastolic velocity ≤8 cm/s) in patients with “corrected” aortic coarctation and its relationship to patient demographics and aortic elastic properties.

Methods: A retrospective study of 80 consecutive patients with “corrected” aortic coarctation (aged 27 (SD 6) years, seven postballoon aortoplasty, 41 poststenting and 32 postsurgical repair) was carried out. Patients’ ages at intervention, comorbidities and medications were recorded. The LV long axis motions were recorded by M-mode and PW TDI. Aortic stiffness indices were calculated from the aortic diameters and pulse pressures.

Results: Forty-seven patients (59%) had LAD. They were older (28 (5) vs 9 (6) years) at treatment, had stiffer aorta (stiffness index 18.4 (6.0) vs 9.2 (2.3)), thicker LV walls (146.7 (59.7) vs 103.8 (44.9) g/m²), higher wall stress (80 (6) vs 70 (7) 10³ dynes/cm²), larger left atria (31.7 (4.6) vs 24.5 (5.3) ml/m²) and higher LV filling pressures (p<0.01 for all) compared with those without LAD, despite a similar prevalence of antihypertensive use and bicuspid aortic valves. The age at intervention (OR 2.92, 95% CI 1.29 to 6.60, p<0.01) and aortic stiffness index (OR 1.98, 95% CI 1.41 to 2.79, p<0.001) were the two independent predictors for LAD in patients on multivariate analysis. A cut-off age of ≥25 year at intervention was 89% sensitive and 76% specific in predicting LAD (AUC = 0.90, p<0.001).

Conclusions: LAD is common in adults with aortic coarctation despite apparently successful treatment. Its presence is related to older age at intervention and increased aortic stiffness.