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Left ventricular long axis dysfunction in adults with corrected aortic coarctation is related to an older age at intervention and increased aortic stiffness.
  1. Yat Yin Lam (homalam{at}hotmail.com)
  1. Chinese University of Hong Kong, Hong Kong
    1. Mike J Mullen
    1. Royal Brompton Hospital, United Kingdom
      1. Mehmet Gungor Kaya
      1. Erciyes University, Turkey
        1. Wei Li
        1. Royal Brompton Hospital, United Kingdom
          1. Michael A Gatzoulis
          1. Royal Brompton Hospital, United Kingdom
            1. Michael Y Henein
            1. Heart Centre, Norrlands University Hospital, Uema, Sweden

              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 ≤8cm/s] in patients with corrected aortic coarctation and its relationship to patient demographics and aortic elastic properties.

              Methods: We retrospectively studied 80 consecutive patients with corrected aortic coarctation (aged 27±6 years, 7 post balloon aortoplasty, 41 post stenting and 32 post surgical repair). Patients' age at intervention, co-morbidities 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 vs. 9.2±7), thicker LV walls (146.7±59.7 vs. 103.8±44.9 gm/m2), higher wall stress (80±6 vs. 70±7 103dynes/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 to those without LAD despite similar prevalence of anti-hypertensive use and bicuspid aortic valves. The age at intervention (OR 2.92, 95% CI 1.29-6.60, p<0.01) and aortic stiffness index (OR 1.98, 95% CI 1.41-2.79, 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.

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