Cardiac Remodeling and Disease Progression in Patients With Repaired Coarctation of Aorta and Aortic Stenosis.
Cardiac Remodeling and Disease Progression in Patients With Repaired Coarctation of Aorta and Aortic Stenosis.
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DOI：
10.1161/circimaging.121.013383
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发表时间：
2021-12
期刊：
影响因子：
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通讯作者：
Pellikka PA
中科院分区：
文献类型：
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作者：
Egbe AC;Oh JK;Pellikka PA
Valvuloarterial impedance (Zva) is used for assessment of left ventricular (LV) global pressure load in patients with aortic stenosis (AS) and impaired arterial compliance. Since patients with repaired coarctation of aorta (r-COA) have impaired arterial compliance, we hypothesized that COA patients with greater than or equal to moderate AS (AS-COA group) will have higher Zva, symptomatic progression, and cardiovascular events, as compared to non-COA patients with similar AS severity (AS group). 1:1 propensity matching of 71 AS-COA and 71 AS patients based on age, sex, body mass index, and aortic valve mean gradient (Cohort 1). Of 172 patients, 117 patients (AS-COA [n=62]; AS [n=55]) underwent aortic valve replacement (AVR), Cohort 2. Cohort 1 was used to assess the relationship between pre-operative Zva, cardiac remodeling and symptomatic progression, while Cohort 2 was used to assess the relationship between post-operative Zva, LV mass index (LVMI) regression (reduction in LVMI after AVR) and cardiovascular events. The AS-COA group had higher Zva (4.2±0.6 vs 3.5±0.4 mmHg/ml*m2, p<0.001), more advanced cardiac remodeling, and higher 5-year incidence of symptomatic progression (85% vs 51%, p<0.001). Pre-operative Zva was independently associated with cardiac remodeling (r=0.66, p<0.001) and symptomatic progression (HR 1.06, 1.02–1.10, per mmHg/ml*m2 increase in Zva). The AS-COA group had higher post-operative Zva (3.3±0.5 vs 2.4±0.4 mmHg/ml*m2, p<0.001), less robust LVMI regression at 1-year post-AVR, and higher 5-year incidence of cardiovascular events. Post-operative Zva was independently associated with LVMI regression (r=-0.46, p<0.001) and cardiovascular events (HR 1.06, 1.02–1.10, per mmHg/ml*m2 increase in Zva). Adults with AS-COA had higher LV global pressure load, cardiac remodeling, symptomatic progression, and cardiovascular events as compared to non-COA patients with similar severity of AS. Zva can identify patients at risk for adverse outcomes, and perhaps should be used for risk stratification with regards to timing of AVR.
