P2741Predictors of subtle left ventricular systolic dysfunction after treatment of coarctation of the aorta
Authors: Saber Hafez M , Adel Ezzeldin D , Abdel Razek Esmail Y , Mohamed Attia H , Mahmoud Roshdy A , Hamdy El Sayed M 
Published: October 2019

Abstract

Background
With the advent of the term “Heart Failure with Preserved Ejection Fraction - HFpEF”, more and more evidence has emerged supporting the importance of Speckle Tracking Echocardiography in measurement of Left ventricular (LV) Strain to assess subtle myocardial systolic dysfunction in such patients. Aim: To assess Global Longitudinal stain (GLS) of the LV in patients with Coarctation of the Aorta (CoA) after surgical or percutaneous treatment and predict the variables affecting the occurrence of subtle myocardial dysfunction in these patients.

Patients and methods
This was a cross sectional observational study that included 77 patients who presented to Ain Shams University hospital for follow up post treatment of Coarctation of the Aorta. All of these patients underwent intervention (surgical or catheter based) in the period between January 2005 and December 2017 and aged between 15 and 40 years at the time of the study. The patients underwent a detailed transthoracic echocardiogram, including Speckle Tracking using Phillips Q Lab version 7.1 software. All patients had normal systolic functions as measured by LV ejection fraction using Modified Simpsons' method. Correlations between variables were studied using “Independent paired T test and Chi square test”.

Results
The mean follow up duration was 13.19±3 years. The least accepted GLS value using the Phillips Q Lab version 7.1 software was −16.4%. Accordingly, the study group was divided into two groups (Normal GLS and Abnormal GLS). Nineteen patients had a low GLS, representing 24% of the study population. There was no age nor sex predilection between the two groups. Age at first intervention correlated positively with GLS (p=0.01), meaning that earlier intervention lead to better LV strain as the GLS is a negative value. Patients with Bicuspid Aortic Valve and those having Left ventricular Hypertrophy had significantly lower GLS (p=0.001). Patients with continuous abdominal Aortic flow had significantly lower GLS as compared to patients with pulsatile flow (p=0.005) (see figure). The occurrence of complications, e.g. stent fracture or recoarctation caused a significant reduction in GLS (p=0.012). Type of intervention, Order of interventions and age at second and third interventions did not significantly affect the GLS. CoA dimensions by MSCT and presence of Hypertension both before and after treatment did not affect the GLS.
Effect of Aortic flow on GLS

Conclusions
Although most patients post CoA repair have normal LV ejection fraction, a good proportion of them have impaired LV global longitudinal strain and are thus prone to HFpEF. Earlier age at intervention, absence of complications and LV hypertrophy, as well as presence of pulsatile Abdominal Aortic flow lead to better LV performance as measured by GLS. LV strain derived from Speckle Tracking Echocardiography should be an integral part of follow up of CoA patients after repair.

Acknowledgement/Funding
None