Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France.
Medical School, UNICAEN, CHU Caen, Université Caen Normandie, 4650, Caen, EA, France.
Pediatr Cardiol. 2021 Jan;42(1):199-209. doi: 10.1007/s00246-020-02471-3. Epub 2020 Sep 25.
This study examined the left atrial (LA) function using two-dimensional (2D) strain analysis after aortic coarctation (CoA) repair, as well as relationships between LA function and patient characteristics, especially aortic arch anatomy. 56 patients (34 males, age: 31 ± 16 years) with CoA repair (46 post 'end-to-end anastomosis/subclavian flap') and 56 controls were studied. 2D strain imaging was performed to assess left ventricular (LV) and LA functions including peak-positive LA strain, early and late diastolic LA strains, and global longitudinal (LV-GLS) and circumferential (LV-GCS) strains. LA dysfunction (LAD) was defined as a peak-positive LA strain value lower than the mean value of the control group minus 2 SDs. Peak-positive LA strain, early and late diastolic LA strains, and LV-GLS were significantly lower in the CoA group while LV-GCS did not differ. No significant correlation was found between LA strain and either current age, age at initial repair, or blood pressure; Ea and LV-GLS were moderately correlated to peak-positive LA strain (r = 0.49, p < 0.001 and r = - 0.55, p < 0.001, respectively). 23 CoA patients (41%) presented LAD (abnormal peak-positive LA strain < 25%). Among patients who underwent end-to-end anastomosis/subclavian flap, those with a non-romanesque aortic arch anatomy exhibited a significantly lower peak-positive LA strain. Ischemic stroke and atrial arrhythmia were more frequent in CoA patients with LAD. Our findings suggest that LAD may be prevalent late after CoA repair. Postoperative aortic arch anatomy may impact peak-positive LA strain.
这项研究通过二维（2D）应变分析检查了主动脉缩窄（CoA）修复后的左心房（LA）功能，以及 LA 功能与患者特征之间的关系，尤其是主动脉弓解剖结构之间的关系。研究纳入了 56 名 CoA 修复患者（34 名男性，年龄：31±16 岁，其中 46 例行“端对端吻合/锁骨下 flap”术式）和 56 名对照者。使用二维应变成像评估左心室（LV）和 LA 功能，包括 LA 应变峰值、舒张早期和晚期 LA 应变以及 LV 整体纵向应变（LV-GLS）和周向应变（LV-GCS）。将 LA 功能障碍（LAD）定义为 LA 应变峰值低于对照组平均值减去 2 个标准差。CoA 组的 LA 应变峰值、舒张早期和晚期 LA 应变以及 LV-GLS 明显低于对照组，而 LV-GCS 则无差异。LA 应变与当前年龄、初次修复年龄或血压均无显著相关性；Ea 和 LV-GLS 与 LA 应变峰值中度相关（r=0.49，p<0.001 和 r= - 0.55，p<0.001）。23 名 CoA 患者（41%）存在 LAD（LA 应变峰值异常<25%）。在接受端对端吻合/锁骨下 flap 术式的患者中，主动脉弓非罗马式解剖结构的患者 LA 应变峰值明显较低。伴有 LAD 的 CoA 患者更易发生缺血性脑卒中及房性心律失常。本研究提示 CoA 修复后晚期 LAD 可能较为常见。术后主动脉弓解剖结构可能影响 LA 应变峰值。
