TY - JOUR
T1 - Left ventricular adaptation to aortic regurgitation in adults with repaired coarctation of aorta
AU - Egbe, Alexander C.
AU - Miranda, William R.
AU - Anderson, Jason H.
AU - Pellikka, Patricia A.
AU - Stephens, Elizabeth H.
AU - Andi, Kartik
AU - Abozied, Omar
AU - Connolly, Heidi M.
N1 - Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/7/15
Y1 - 2023/7/15
N2 - Background: Aortic regurgitation (AR) can develop in adults with repaired coarctation of aorta (COA), but there are limited data about left ventricular (LV) remodeling and clinical outcomes in this population. The purpose of the study was to compare LV remodeling (LV mass index [LVMI], LV ejection fraction [LVEF], and septal E/e′) and onset of symptoms before aortic valve replacement, and LV reverse remodeling (%-change in LVMI, LVEF and E/e′) after aortic valve replacement in patients with versus without repaired COA presenting with AR. Methods: Asymptomatic adults with repaired COA presenting with moderate/severe AR (AR-COA group) were matched 1:2 to asymptomatic adults without COA and similar severity of AR (control group). Results: Although both groups (AR-COA n = 52, and control n = 104) had similar age, sex, body mass index, aortic valve gradient, and AR severity, the AR-COA group had higher LVMI (124 ± 28 versus 102 ± 25 g/m2, p < 0.001) and E/e′ (12.3 ± 2.3 versus 9.5 ± 2.1, p = 0.02) but similar LVEF (63 ± 9% versus 67 ± 10%, p = 0.4). COA diagnosis (adjusted HR 1.95, 95%CI 1.49–2.37, p < 0.001), older age, E/e′, and LV hypertrophy were associated with onset of symptoms. Of 89 patients (AR-COA n = 41, and control n = 48) with echocardiographic data at 1-year post- aortic valve replacement, the AR-COA group had less regression of LVMI (−8% [95%CI -5 to −11] versus −17% [95%CI -15 to −21], p < 0.001) and E/e′ (−5% [95% CI -3 to −7] versus −16% [95% CI -13 to −19], p < 0.001). Conclusions: Patients with COA and AR had a more aggressive clinical course, and perhaps may require a different threshold for surgical intervention.
AB - Background: Aortic regurgitation (AR) can develop in adults with repaired coarctation of aorta (COA), but there are limited data about left ventricular (LV) remodeling and clinical outcomes in this population. The purpose of the study was to compare LV remodeling (LV mass index [LVMI], LV ejection fraction [LVEF], and septal E/e′) and onset of symptoms before aortic valve replacement, and LV reverse remodeling (%-change in LVMI, LVEF and E/e′) after aortic valve replacement in patients with versus without repaired COA presenting with AR. Methods: Asymptomatic adults with repaired COA presenting with moderate/severe AR (AR-COA group) were matched 1:2 to asymptomatic adults without COA and similar severity of AR (control group). Results: Although both groups (AR-COA n = 52, and control n = 104) had similar age, sex, body mass index, aortic valve gradient, and AR severity, the AR-COA group had higher LVMI (124 ± 28 versus 102 ± 25 g/m2, p < 0.001) and E/e′ (12.3 ± 2.3 versus 9.5 ± 2.1, p = 0.02) but similar LVEF (63 ± 9% versus 67 ± 10%, p = 0.4). COA diagnosis (adjusted HR 1.95, 95%CI 1.49–2.37, p < 0.001), older age, E/e′, and LV hypertrophy were associated with onset of symptoms. Of 89 patients (AR-COA n = 41, and control n = 48) with echocardiographic data at 1-year post- aortic valve replacement, the AR-COA group had less regression of LVMI (−8% [95%CI -5 to −11] versus −17% [95%CI -15 to −21], p < 0.001) and E/e′ (−5% [95% CI -3 to −7] versus −16% [95% CI -13 to −19], p < 0.001). Conclusions: Patients with COA and AR had a more aggressive clinical course, and perhaps may require a different threshold for surgical intervention.
KW - Aortic regurgitation
KW - Aortic valve replacement
KW - Coarctation of aorta
KW - Left ventricular remodeling
UR - http://www.scopus.com/inward/record.url?scp=85159653363&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85159653363&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2023.04.061
DO - 10.1016/j.ijcard.2023.04.061
M3 - Article
C2 - 37149005
AN - SCOPUS:85159653363
SN - 0167-5273
VL - 383
SP - 62
EP - 69
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -