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. 2020 Sep;13(9):1863-1872.
doi: 10.1016/j.jcmg.2020.01.016. Epub 2020 Mar 18.

Left Ventricular Remodeling After Transcatheter Versus Surgical Therapy in Adults With Coarctation of Aorta

Alexander C Egbe  1 , Jason H Anderson  2 , Naser M Ammash  3 , Nathaniel W Taggart  2
Affiliations

Left Ventricular Remodeling After Transcatheter Versus Surgical Therapy in Adults With Coarctation of Aorta

Alexander C Egbe et al. JACC Cardiovasc Imaging. 2020 Sep.

Abstract

Objectives: The purpose of this retrospective cohort study was to compare remodeling of left ventricular (LV) structure and function after transcatheter stent therapy with remodeling of LV structure and function after surgical therapy for COA.

Background: Transcatheter stent therapy is as effective as surgery in producing acute hemodynamic improvement in patients with coarctation of aorta (COA). However, LV remodeling after transcatheter COA intervention has not been systematically investigated.

Methods: LV remodeling was assessed at 1, 3, and 5 years post-intervention by using LV mass index (LVMI), LV end-diastolic dimension, LV ejection fraction, LV global longitudinal strain (LVGLS), LV mitral annular tissue Doppler early velocity (LVe'), and ratio of mitral inflow pulsed wave Doppler early velocity and e' (E/e') ratio.

Results: There were 44 patients in the transcatheter group and 128 patients in the surgical group. Compared to the surgical group, the transcatheter group had less regression of LVMI (-4.6; 95% confidence interval [CI]: -5.5 to -3.7 vs. -7.3; 95% CI: -8.4 to -6.6 g/m2; p < 0.001), less improvement in LVGLS (2.1; 95% CI: 1.8 to 2.4 vs. 2.9; 95% CI: 2.6 to 3.2%; p = 0.024), and in e' (1.0 ; 95% CI: 0.7 to 1.2 vs. 1.5 ; 95% CI: 1.3 to 1.7 cm/s; p = 0.009) at 5 years post-intervention. Exploratory analysis showed a correlation between change in LVMI and LVGLS, and between change in LVMI and mitral annular tissue Doppler early velocity (e'), and this correlations were independent of the type of intervention received.

Conclusions: Transcatheter stent therapy was associated with less remodeling of LV structure and function during mid-term follow-up. As transcatheter stent therapy becomes more widely used in the adult COA population, there is a need for ongoing clinical monitoring to determine if these observed differences in LV remodeling translate to differences in clinical outcomes.

Keywords: coarctation of aorta; left ventricular hypertrophy; left ventricular remodeling; transcatheter stent therapy.

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Conflict of interest statement

Conflict of Interest: none

Figures

Figure 1:
Figure 1:. Box-and-whisker plot comparing changes in left ventricular global longitudinal strain (LVGLS) and left ventricular ejection fraction (LVEF) between the transcatheter stent therapy group (red) and surgical group (black).
Figure highlights between-group differences in LVGLS and LVEF
Figure 2:
Figure 2:. Box-and-whisker plot comparing changes in left ventricular e’ velocity and E/e’ between transcatheter stent therapy group (red) and surgical group (black)
Figure highlights between-group differences in e’ and E/e’
Figure 3:
Figure 3:. Linear regression of changes in LVMI vs changes in LVGLS (A), and changes in LVMI vs changes in LV e’ (B). Change in LVMI was plotted as absolute values (even the net change was negative)
Figure highlights change in LVMI per unit change in LVGLS and LV e’
Central illustration:
Central illustration:. Box-and-whisker plot comparing changes in left ventricular mass index (LVMI) and left ventricular end-diastolic dimension (LVEDD) between the transcatheter stent therapy group (red) and surgical group (black). Data expressed as mean difference (95% confidence interval)
Figure highlights between-group differences in LVMI and LVEDD
See this image and copyright information in PMC

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