Author + information
- Received November 6, 2019
- Revision received January 8, 2020
- Accepted January 17, 2020
- Published online September 7, 2020.
- Alexander C. Egbe, MBBS, MPHa,∗ (, )
- Jason H. Anderson, MDb,
- Naser M. Ammash, MDa and
- Nathaniel W. Taggart, MDb
- aDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- bDivision of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Alexander Egbe, Mayo Clinic and Foundation, 200 First Street SW, Rochester, Minnesota 55905.
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.
- coarctation of aorta
- left ventricular hypertrophy
- left ventricular remodeling
- transcatheter stent therapy
Dr. Egbe is supported by a U.S. National Institutes of Health/National Heart, Lung, and Blood Institute grant K23 HL141448-01. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received November 6, 2019.
- Revision received January 8, 2020.
- Accepted January 17, 2020.
- 2020 American College of Cardiology Foundation
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