Di Salvo Giovanni, Fumanelli Jennifer, Graziano Serena, Pozza Alice, Cattapan Irene, Moscatelli Sara, Castaldi Biagio, Galzerano Domenico
Pediatric Cardiology and Adult Congenital Unit, Department of Women's and Child's Health, University of Padua, 35121 Padova, Italy.
Working Group on Congenital Heart Disease and Cardiovascular Prevention of the Italian Society of Cardiology, 00136 Roma, Italy.
J Clin Med. 2024 Sep 20;13(18):5587. doi: 10.3390/jcm13185587.
Aortic coarctation (CoA) is a congenital heart disease affecting 5-8% of patients, with long-term complications persisting despite successful correction. Stress echocardiography (SE) is increasingly used for evaluating cardiac function under stress, yet its role in repaired CoA remains under-explored. This study aimed to assess the predictive value of SE and myocardial strain in repaired CoA patients with a history of hypertension without significant gradients or with borderline gradients at rest. Between June 2020 and March 2024, we enrolled 35 consecutive CoA patients with successful repairs and either a history of hypertension or borderline Doppler gradients. Baseline and peak exercise echocardiographic measurements, including left ventricular mass index (LVMi) and global longitudinal strain (LVGLS), were recorded. Patients were followed for up to 4 years. At baseline, the positive SE group had higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to the negative SE group. The positive SE group also exhibited significantly higher basal and peak trans-isthmic gradients. Positive SE was found in 45.7% of patients, with 68.7% of these requiring re-intervention during follow-up. A peak trans-isthmic gradient > 61 mmHg during exercise predicted recoarctation with 100% sensitivity and 71% specificity (AUC = 0.836, < 0.004). SE identifies at-risk patients post-CoA repair, aiding in early intervention. A peak trans-isthmic gradient > 61 mmHg during exercise is a strong predictor of recoarctation. These findings support incorporating SE into routine follow-up protocols for CoA patients, particularly those with a history of hypertension and borderline gradients, to improve long-term outcomes and quality of life.
主动脉缩窄（CoA）是一种先天性心脏病，影响5%-8%的患者，尽管矫正成功，但长期并发症仍会持续存在。负荷超声心动图（SE）越来越多地用于评估负荷状态下的心脏功能，但其在CoA修复术后的作用仍有待进一步探索。本研究旨在评估SE和心肌应变对有高血压病史、静息时无明显压差或临界压差的CoA修复术后患者的预测价值。在2020年6月至2024年3月期间，我们连续纳入了35例CoA修复成功且有高血压病史或临界多普勒压差的患者。记录了包括左心室质量指数（LVMi）和整体纵向应变（LVGLS）在内的基线和运动高峰时的超声心动图测量值。对患者进行了长达4年的随访。在基线时，SE阳性组的收缩压（SBP）和舒张压（DBP）高于SE阴性组。SE阳性组的基础和峡部峰值压差也显著更高。45.7%的患者SE呈阳性，其中68.7%的患者在随访期间需要再次干预。运动时峡部峰值压差>61 mmHg预测再缩窄的敏感性为100%，特异性为71%（AUC = 0.836，<0.004）。SE可识别CoA修复术后的高危患者，有助于早期干预。运动时峡部峰值压差>61 mmHg是再缩窄的有力预测指标。这些发现支持将SE纳入CoA患者的常规随访方案，特别是那些有高血压病史和临界压差的患者，以改善长期预后和生活质量。
