Objectives The purpose of this retrospective cohort study was to compare remodeling of left ventricular (LV) structure and function after transcatheter stent therapy with remodeling of LV structure and function after surgical therapy for COA. Background Transcatheter stent therapy is as effective as surgery in producing acute hemodynamic improvement in patients with coarctation of aorta (COA). However, LV remodeling after transcatheter COA intervention has not been systematically investigated. Methods LV remodeling was assessed at 1, 3, and 5 years post-intervention by using LV mass index (LVMI), LV end-diastolic dimension, LV ejection fraction, LV global longitudinal strain (LVGLS), LV mitral annular tissue Doppler early velocity (LVe′), and ratio of mitral inflow pulsed wave Doppler early velocity and e′ (E/e′) ratio. Results There were 44 patients in the transcatheter group and 128 patients in the surgical group. Compared to the surgical group, the transcatheter group had less regression of LVMI (−4.6; 95% confidence interval [CI]: −5.5 to −3.7 vs. −7.3; 95% CI: −8.4 to −6.6 g/m2; p < 0.001), less improvement in LVGLS (2.1; 95% CI: 1.8 to 2.4 vs. 2.9; 95% CI: 2.6 to 3.2%; p = 0.024), and in e′ (1.0 ; 95% CI: 0.7 to 1.2 vs. 1.5 ; 95% CI: 1.3 to 1.7 cm/s; p = 0.009) at 5 years post-intervention. Exploratory analysis showed a correlation between change in LVMI and LVGLS, and between change in LVMI and mitral annular tissue Doppler early velocity (e′), and this correlations were independent of the type of intervention received. Conclusions Transcatheter stent therapy was associated with less remodeling of LV structure and function during mid-term follow-up. As transcatheter stent therapy becomes more widely used in the adult COA population, there is a need for ongoing clinical monitoring to determine if these observed differences in LV remodeling translate to differences in clinical outcomes.

中文翻译：

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成人主动脉缩窄经导管与手术治疗后的左心室重塑。


目的 这项回顾性队列研究的目的是比较经导管支架治疗后左心室 (LV) 结构和功能的重塑与 COA 手术治疗后左心室 (LV) 结构和功能的重塑。背景 经导管支架治疗与手术一样有效地改善主动脉缩窄 (COA) 患者的血流动力学。然而，经导管 COA 干预后的左室重塑尚未得到系统研究。方法 使用左室质量指数 (LVMI)、左室舒张末期尺寸、左室射血分数、左室整体纵向应变 (LVGLS)、左室二尖瓣环组织多普勒早期速度评估干预后 1 年、3 年和 5 年的左室重塑情况(LVe')、二尖瓣流入脉冲波多普勒早期速度与e'的比值(E/e')。结果 经导管组44例，手术组128例。与手术组相比，经导管组的 LVMI 回归较少（-4.6；95% 置信区间 [CI]：-5.5 至 -3.7 对比 -7.3；95% CI：-8.4 至 -6.6 g/m2；p < 0.001），LVGLS 改善较小（2.1；95% CI：1.8 至 2.4 vs. 2.9；95% CI：2.6 至 3.2%；p = 0.024），e′（1.0；95% CI：0.7 至1.2 vs. 1.5；95% CI：1.3 至 1.7 cm/s；p = 0.009）干预后 5 年。探索性分析显示 LVMI 和 LVGLS 的变化之间以及 LVMI 和二尖瓣环组织多普勒早期速度 (e') 的变化之间存在相关性，并且这种相关性与所接受的干预类型无关。结论 经导管支架治疗与中期随访期间左心室结构和功能重塑较少相关。 随着经导管支架治疗在成人 COA 人群中的应用越来越广泛，需要持续进行临床监测，以确定观察到的左室重塑差异是否会转化为临床结果的差异。