Egbe Alexander C, Miranda William R, Connolly Heidi M
The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States.
Int J Cardiol Heart Vasc. 2020 May 18;28:100530. doi: 10.1016/j.ijcha.2020.100530. eCollection 2020 Jun.
Left ventricular (LV) pressure overload and coronary artery disease are common in patients with coarctation of aorta (COA), and they are risk factors for LV diastolic dysfunction. Patients with COA may have aortic vasculopathy that can result in LV pressure overload even in the absence of hemodynamically significant COA. We therefore hypothesized that patients with mild COA (without hemodynamically significant COA) will have more LV diastolic dysfunction compared to controls.
Adult patients with mild COA (Doppler peak velocity < 2.5 m/s) were matched 1:1 to patients without structural heart disease using propensity score method based on age, sex, body mass index, hypertension and blood pressure. The objective was to compare LV diastolic dysfunction (defined as E/e' > 2 standard deviations above age-specific normative values) between adults with repaired COA and controls.
Of 204 COA and 204 control patients (age 35 ± 12 years), patients with COA had higher septal and lateral E/e' ratio (12 ± 4 vs 9 ± 4, p = 0.009) and (10 ± 3 vs 7 ± 3, p < 0.001), respectively. Compared to controls, the prevalence of LV diastolic dysfunction was higher in patients with COA for every age group: <40 years (63% vs 13%, p < 0.001); 41-60 years (87% vs 33%, p < 0.001); age > 60 years (82% vs 56%, p = 0.076). Left ventricular mass index (LVMI) was the strongest determinant of E/e' (β = 2.71 per 10 g/m, standard error = 1.25, p < 0.001).
LV diastolic dysfunction was common in patients with COA, and the association with LVMI suggests that patients with COA may have ongoing LV pressure overload in the absence of hemodynamically significant re-coarctation.
左心室（LV）压力超负荷和冠状动脉疾病在主动脉缩窄（COA）患者中很常见，它们是左心室舒张功能障碍的危险因素。COA患者可能存在主动脉血管病变，即使在没有血流动力学显著意义的COA情况下也可导致左心室压力超负荷。因此，我们推测轻度COA（无血流动力学显著意义的COA）患者与对照组相比，左心室舒张功能障碍更多见。
使用倾向评分法，根据年龄、性别、体重指数、高血压和血压，将成年轻度COA患者（多普勒峰值速度<2.5 m/s）与无结构性心脏病的患者按1:1匹配。目的是比较修复COA的成年人与对照组之间的左心室舒张功能障碍（定义为E/e'>高于年龄特异性正常值2个标准差）。
在204例COA患者和204例对照患者（年龄35±12岁）中，COA患者的室间隔和侧壁E/e'比值更高，分别为（12±4对9±4，p = 0.009）和（10±3对7±3，p < 0.001）。与对照组相比，各年龄组COA患者左心室舒张功能障碍的患病率更高：<40岁（63%对13%，p < 0.001）；41 - 60岁（87%对33%，p < 0.001）；>60岁（82%对56%，p = 0.076）。左心室质量指数（LVMI）是E/e'的最强决定因素（β = 2.71每10 g/m，标准误 = 1.25，p < 0.001）。
左心室舒张功能障碍在COA患者中很常见，与LVMI的关联表明，在没有血流动力学显著意义的再缩窄情况下，COA患者可能存在持续的左心室压力超负荷。
