scholarly journals Letter by Quail and Muthurangu Regarding Article, “Doppler-Derived Arterial Load Indices Better Reflect Left Ventricular Afterload Than Systolic Blood Pressure in Coarctation of Aorta”

2020 ◽  
Vol 13 (4) ◽  
Author(s):  
Michael A. Quail ◽  
Vivek Muthurangu
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Left Ventricular ◽  
Coarctation Of Aorta ◽  
Left Ventricular Afterload ◽  
Ventricular Afterload ◽  
Arterial Load ◽  
Load Indices

Determinants of left ventricular hypertrophy and dysfunction in adults with coarctation of aorta

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Egbe ◽  
R Vojjini ◽  
K Banala
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Global Longitudinal Strain ◽  
Pressure Overload ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Coarctation Of Aorta ◽  
Post Intervention ◽  
Aortic Isthmus ◽  
Lv Remodeling

Abstract Background Several coarctation of aorta (COA) severity indices are used for timing of COA intervention, and to define severity of residual coarctation post-intervention. However, it is unclear how many of these COA indices are required in order to recommend intervention, and what degree of residual coarctation results in suboptimal recovery of the left ventricle (LV). Our aim was to assess the correlation between different COA indices and effects of chronic LV pressure overload (LV hypertrophy, diastolic and systolic dysfunction), and to determine the effect of residual coarctation on LV reverse remodeling after COA intervention. Methods COA severity indices were defined as Doppler COA gradient, systolic blood pressure, upper-to-lower-extremity systolic blood pressure gradient, aortic isthmus ratio. LV remodeling indices were defined as LV mass index (LVMI), LV global longitudinal strain (LVGLS), e' and E/e'. LV reverse remodeling was defined as the difference between indices obtained pre-intervention and 5-years post-intervention (delta LVMI, e', E/e', LVGLS). Results Of the COA indices analyzed in 546 adult COA patients, aortic isthmus ratio had the strongest correlation with LVMI (β±standard error −28.3±14.1, p<0.001), LVGLS (1.51±0.42, p=0.005), e' (3.11±1.10, p=0.014), and E/e' (−13.4±6.67, p=0.008). Residual aortic isthmus ratio also had the strongest correlation with LV reverse remodeling, and residual aortic isthmus ratio <0.7 was predictive of suboptimal LV reverse remodeling post-intervention. Conclusion Considering the known prognostic implications of LV remodeling and reverse remodeling in response to pressure overload, these results support the use of aortic isthmus ratio for timing of COA intervention, and for prognostication post-intervention. Funding Acknowledgement Type of funding source: None

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