BACKGROUND Coarctation of aorta (COA) results in chronic left ventricular (LV) pressure overload and subsequently leads to LV diastolic dysfunction and heart failure over time. The goal of COA intervention is to prevent these complications. The timing of COA interventions is based on the presence of these COA severity indices: doppler mean COA gradient, systolic blood pressure, upper-to-lower-extremity SBP gradient, aortic isthmus ratio, presence of collaterals, and exercise-induced hypertension. Although these indices are physiologically intuitive, the relationship between these indices and LV diastolic dysfunction and exertional symptoms has not been studied. The purpose of this study was to evaluate the association between the indices of COA severity and LV diastolic function and symptoms. METHODS In this cross-sectional study, multivariate linear and logistic regression analyses were used to assess the correlation between indices of COA severity, LV diastolic function (average e' and E/e'), and exertional symptoms (NYHA II-IV and peak oxygen consumption). RESULTS Of all the COA indices analyzed in 546 adult COA patients, aortic isthmus ratio had the strongest correlation with e' (β [95% CI]: 3.11 [2.02-4.31]; P=0.014) per 1 cm/second; E/e' (-13.4 [-22.3 to -4.81]; P=0.009) per 1 unit; peak oxygen consumption (4.05 [1.97-6.59] per 1% change, P=0.019), and NYHA II to IV symptoms (odds ratio, 2.16 [1.65-3.18]; P=0.006). CONCLUSIONS Of all the COA severity indices stipulated in the guidelines, aortic isthmus ratio had the strongest correlation with LV diastolic function and exertional symptoms. As LV diastolic dysfunction typically precede heart failure symptoms, we anticipate that the results of this study will improve and simplify patient selection for COA intervention and potentially improve long-term outcomes.

中文翻译：

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主动脉缩窄成人左心室舒张功能和用力症状的决定因素。


背景主动脉缩窄（COA）导致慢性左心室（LV）压力超负荷，并随后随着时间的推移导致左心室舒张功能障碍和心力衰竭。 COA 干预的目标是预防这些并发症。 COA 干预的时机基于这些 COA 严重程度指标的存在：多普勒平均 COA 梯度、收缩压、上肢到下肢 SBP 梯度、主动脉峡部比率、侧支循环的存在和运动诱发的高血压。尽管这些指标在生理上是直观的，但这些指标与左心室舒张功能障碍和劳力症状之间的关系尚未被研究。本研究的目的是评估 COA 严重程度指数与左室舒张功能和症状之间的关联。方法 在这项横断面研究中，采用多元线性和逻辑回归分析来评估 COA 严重程度、左心室舒张功能（平均 e' 和 E/e'）以及劳力症状（NYHA II-IV 和峰值）之间的相关性。耗氧量）。结果 在 546 名成年 COA 患者分析的所有 COA 指数中，主动脉峡部比与每 1 cm/秒 e' (β [95% CI]: 3.11 [2.02-4.31]; P=0.014) 的相关性最强； E/e'（-13.4 [-22.3 至 -4.81]；P=0.009）每 1 单位；峰值耗氧量（每 1% 变化 4.05 [1.97-6.59]，P=0.019），以及 NYHA II 至 IV 症状（比值比，2.16 [1.65-3.18]；P=0.006）。结论 在指南规定的所有COA严重程度指标中，主动脉峡部比与左心室舒张功能和劳力症状的相关性最强。 由于左心室舒张功能障碍通常先于心力衰竭症状出现，我们预计这项研究的结果将改善和简化 COA 干预的患者选择，并有可能改善长期结果。