Reverse Cardiac Remodeling Induced by Endovascular Treatment of Coarctation of the Aorta

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-05-05 DOI:10.1111/echo.70181

Melody Farrashi, Shirin Habibi Khorasani, Ahmadreza Tanbakookar, Hamid Reza Pouraliakbar, Bahram Mohebbi, Jamal Moosavi, Mohammadreza Iranian, Seyed Mohammad Forouzannia, Mohammadreza Babaei, Arya Afrooghe, Ata Firouzi, Reza Kiani, Amineh Safavirad, Ehsan Khalilipur, Zahra Khajali, Sedigheh Saedi, Hooman Bakhshandeh, Parham Sadeghipour

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引用次数: 0

Abstract

Background

Limited research has explored the transformation of echocardiographic parameters during mid- to long-term follow-up in patients with native coarctation of the aorta (CoA) managed through stenting. This study assesses changes in echocardiographic parameters among patients undergoing stent coarctoplasty, by comparing baseline and 3-year transthoracic echocardiographic (TTE) parameters.

Methods

In our earlier work, we detailed the 3-year clinical safety and efficacy outcomes of balloon-expandable versus self-expandable stents for treating native CoA within a randomized clinical trial. The current substudy aims to assess the mid-term effects of stenting by examining all participants with available baseline and 3-year core laboratory-confirmed TTE data.

Results

Of the 92 patients enrolled in the randomized trial, 32 individuals (median age: 32 years [IQR: 24.8–37.5]) were included in this substudy. At the 3-year follow-up, significant improvements were observed in myocardial diastolic function, characterized by increased septal E′ and lateral E′ velocities (p = 0.02 and p = 0.03, respectively) and decreased septal and lateral E/E′ ratios (10.84 ± 2.83 to 9.21 ± 3.17, p = 0.02 and 7.39 ± 2.24 to 6.29 ± 1.97, p = 0.02, respectively). At the 3-year follow-up, a significant reduction in left ventricular (LV) mass was observed, decreasing from 160 g (IQR: 130–203) to 142 g (IQR: 121–172) (p = 0.001). Among the 12 patients (37.5%) presenting with baseline LV hypertrophy, nine individuals (75%) experienced normalization, demonstrating a substantial improvement in LV mass. Additionally, the prevalence of diastolic dysfunction significantly decreased from 12 patients (41.3%) to four patients (13.7%) at the 3-year evaluation.

Conclusions

In adult patients with de novo native CoA, stent coarctoplasty was found to result in significant and sustained improvements in LV diastolic function and reduced LV mass during the mid-term follow-up. Our findings imply that baseline structural parameters may serve as stronger predictors of long-term therapeutic outcomes than demographic factors.

Trail Registration

Iranian Registry of Clinical Trials: IRCT20181022041406N3.

Abstract Image

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血管内治疗主动脉缩窄引起的逆转心脏重构

背景有限的研究探讨了通过支架置入术治疗先天性主动脉缩窄（CoA）患者中长期随访期间超声心动图参数的变化。本研究通过比较基线和3年经胸超声心动图（TTE）参数，评估接受支架成形术患者超声心动图参数的变化。在我们早期的工作中，我们在一项随机临床试验中详细介绍了球囊可膨胀支架与自膨胀支架治疗天然CoA的3年临床安全性和有效性结果。当前的子研究旨在通过检查所有参与者的基线和3年核心实验室确认的TTE数据来评估支架置入的中期效果。结果在纳入随机试验的92例患者中，32例（中位年龄：32岁[IQR: 24.8-37.5]）被纳入本亚研究。在3年随访中，心肌舒张功能明显改善，表现为室间隔E′和外侧E′速度增加（p = 0.02和p = 0.03），室间隔E′和外侧E′比值降低（10.84±2.83至9.21±3.17,p = 0.02和7.39±2.24至6.29±1.97,p = 0.02）。在3年随访中，观察到左心室（LV）质量显著降低，从160 g （IQR: 130-203）降至142 g (IQR: 121-172) （p = 0.001）。在基线表现为左室肥厚的12例患者（37.5%）中，9例患者（75%）恢复正常，表明左室质量有明显改善。此外，在3年的评估中，舒张功能障碍的患病率从12例（41.3%）显著下降到4例（13.7%）。结论在新生CoA的成年患者中，在中期随访中发现支架成形术可显著且持续地改善左室舒张功能并降低左室质量。我们的研究结果表明，基线结构参数可能比人口因素更能预测长期治疗结果。伊朗临床试验注册中心：IRCT20181022041406N3。

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来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.