Systemic Global Arterial Stiffening is Associated with Adverse Left Ventricular Remodeling in Children Following Coarctation of the Aorta Repair.

Aims

Coarctation of the aorta (COA) is associated with long-term arterial stiffness, and remodeling of the left ventricle (LV) and left atrium (LA). We hypothesized that Doppler-derived indices of arterial load would be associated with LV remodeling in children after successful COA repair.

Methods

In this cross-sectional study, we retrospectively analyzed clinical and echocardiographic data from children after COA repair and age- and sex-matched healthy controls. Arterial load was assessed using Doppler-derived effective arterial elastance index (Eal) and total arterial compliance index (TACI).

Results

The COA group had higher pulse pressure (55.5 (48 - 61) vs 48 (43 - 52) mmHg, p<0.001), lower TACI (0.49 (0.39 - 0.64) vs 0.84 (0.69 - 0.95) ml mmHg-1 m-2, p<0.001), higher Eal (3.49 (2.99 - 4.33) vs 2.51 (2.51 (2.29 - 2.9)) mmHg m2 ml-1, p<0.001), higher LV mass z-score (1.96 (0.99 - 3.13) vs 0.64 (-0.12 - 1.32), p < 0.001) and higher LA volume index (LAVI, 24.34 (21.67 - 31.33) vs 18.73 (15.36 - 24.31) ml m-2, p <0.001) than controls. Lower TACI and male sex were independently associated with LV hypertrophy in multivariate analysis (OR 0.69, 95% CI 0.51-0.92, p = 0.012; and OR 5.88, 95% CI 2.08-16.62, p = 0.001, respectively). Higher LAVI was associated with elevated RV systolic pressure in univariate analysis (OR 1.72, 95% CI 1.07-2.78, p = 0.03).

Conclusion

Children after successful CoA repair demonstrate increased arterial stiffness and early LV and LA remodeling independent of hypertension. Doppler-derived indices of arterial load are readily obtained by standard echocardiography and may improve risk stratification in this population. However, our study design precludes establishing a temporal relationship between altered arterial load and LV remodeling, or demonstrating causality.