Diagnostic and Prognostic Role of Left Ventricular Strain Imaging in Adults with Coarctation of aorta.

The relative diagnostic and prognostic performance of left ventricular (LV) global longitudinal strain (LVGLS) compared with LV ejection fraction (LVEF) and the role of LVGLS for detecting the early stages of LV systolic dysfunction in adults with repaired coarctation of the aorta are unknown. This study aimed to address these knowledge gaps. We used a retrospective cohort study of adults with repaired coarctation of the aorta who underwent transthoracic echocardiogram (2003 to 2020). LV systolic function was assessed using LVEF (derived from volumetric analysis) and LVGLS (derived from speckle-tracking echocardiography). Of the 795 patients (age 36 ± 14 years), the mean LVEF and LVGLS were 62 ± 11% and 21 ± 4%, respectively. The prevalence of LV systolic dysfunction was higher when assessed using LVGLS than using LVEF (20% vs 6%, p <0.001). Of 795 patients, 94 (12%) patients died, of which 75 (9%) died from cardiovascular causes. LVGLS provided more robust prognostic power in predicting the all-cause mortality than LVEF, as evidenced by a higher C-statistic (0.743, 95% confidence interval 0.730 to 0.755 vs 0.782, 95% confidence interval 0.771 to 0.792, p <0.001). Furthermore, patients with normal LVEF in the setting of reduced LVGLS had a higher risk of all-cause mortality (than patients with normal LVGLS and LVEF) and were at risk for a temporal decrease in LVEF during follow-up. These findings suggest that the use of LVGLS for risk stratification can help identify high-risk patients and provide opportunities for interventions, which would, in turn, improve clinical outcomes. Further studies are required to empirically test these postulates.

Prognostic Role of Tricuspid Annular Plane Systolic Excursion/Right Ventricular Systolic Pressure Ratio in Coarctation of Aorta.

Background: Right ventricular (RV) systolic dysfunction and pulmonary hypertension are associated with mortality in adults with coarctation of aorta (COA). The tricuspid annular plane systolic excursion/RV systolic pressure (TAPSE/RVSP) ratio is a validated noninvasive tool for the assessment of RV-pulmonary arterial (RV-PA) coupling in patients with PA hypertension, but similar data are lacking in adults with COA. The purpose of this study was to assess the relationship between the TAPSE/RVSP ratio and outcomes in this population. Methods: A retrospective cohort study of adults with repaired COA was performed. RV systolic dysfunction was defined as RV free wall strain ≥-24% at baseline, whereas new-onset RV systolic dysfunction was defined RV free wall strain ≥-24% during follow-up. Results: Of 661 patients, TAPSE, RVSP, and TAPSE/pulmonary artery systolic pressure ratio were 22 ± 6 mm, 34 ± 12 mm Hg, and 0.71 (0.48-0.89) mm/mm Hg, respectively. Of 661 patients, 152 (23%) had RV systolic dysfunction at baseline, and TAPSE/RVSP <0.43 mm/mm Hg was the optimal threshold to detect RV systolic dysfunction. TAPSE/RVSP <0.43 mm Hg was associated with RV systolic dysfunction (adjusted odds ratio: 3.11 [1.83-6.19], P = 0.004). Of 509 patients with normal RV systolic function, 42 (8%) and 36 (7%) developed new-onset RV systolic dysfunction and new-onset right heart failure, respectively, during follow-up. TAPSE/RVSP <0.43 mm/mm Hg was associated with new-onset RV systolic dysfunction (adjusted hazard ratio: 1.95 [1.46-2.77], P = 0.008) and new-onset right heart failure (adjusted hazard ratio: 0.81 [0.68-0.92], P = 0.005). Conclusions: The TAPSE/RVSP ratio can potentially be used to identify patients at risk for new-onset RV systolic dysfunction and right heart failure and provide opportunity for proactive interventions to prevent adverse outcomes.

Contexte: La dysfonction systolique du ventricule droit (VD) et l'hypertension pulmonaire sont associées à des décès chez les adultes qui présentent une coarctation de l'aorte (CA). Le rapport entre l'excursion systolique du plan de l'anneau tricuspide (TAPSE pour tricuspid annular plane systolic excursion) et la pression systolique du VD (PSVD) est une méthode non invasive pour évaluer le couplage entre le VD et l'artère pulmonaire (VD-AP), qui a été validée chez les patients atteints d'hypertension de l'AP, mais pour laquelle on ne dispose pas de données similaires chez les adultes qui présentent une CA. La présente étude visait à évaluer la relation entre le rapport TAPSE/PSVD et les résultats de santé chez cette population de patients. Méthodologie: Nous avons mené une étude de cohorte rétrospective auprès d'adultes présentant une CA corrigée. La dysfonction systolique du VD était définie comme une déformation (strain) de la paroi libre du VD (DPLVD) ≥ -24 % au début de l'étude, et une dysfonction systolique inaugurale du VD était définie comme une DPLVD ≥ -24 % détectée lors du suivi. Résultats: Pour l'ensemble des 661 patients de l'étude, les valeurs pour la TAPSE, la PSVD et le rapport TAPSE/pression systolique de l'artère pulmonaire étaient respectivement de 22 ± 6 mm, 34 ± 12 mmHg et 0,71 (0,48-0,89) mm/mmHg. Parmi ces 661 patients, 152 (23 %) présentaient initialement une dysfonction systolique du VD, et un rapport TAPSE/PSVD < 0,43 mm/mmHg constituait le seuil optimal pour la détection d'une dysfonction systolique du VD. Un rapport TAPSE/PSVD < 0,43 mm/mmHg était par ailleurs associé à une dysfonction systolique du VD (rapport de cotes ajusté de 3,11 [1,83-6,19], p = 0,004). Au cours du suivi des 509 patients qui présentaient initialement une fonction systolique normale du VD, 42 patients (8 %) ont présenté une dysfonction systolique inaugurale du VD et 36 patients (7 %) ont présenté une insuffisance cardiaque droite inaugurale. Un rapport TAPSE/PSVD < 0,43 mm/mmHg était associé avec la dysfonction systolique inaugurale du VD (rapport des risques instantanés ajusté de 1,95 [1,46-2,77], p = 0,008), et avec l'insuffisance cardiaque droite inaugurale (rapport des risques instantanés ajusté de 0,81 [0,68-0,92], p = 0,005). Conclusions: Le rapport TAPSE/PSVD pourrait permettre de repérer les patients susceptibles de présenter une dysfonction systolique inaugurale du VD ou une insuffisance cardiaque droite inaugurale, ce qui ouvre la voie à des interventions en amont visant à prévenir les résultats défavorables pour ces patients.

Prognostic Performance of Right Ventricular Global Longitudinal Strain Measurements in Patients With Ebstein Anomaly.

BACKGROUND: There are limited data on the prognostic role of right ventricular global longitudinal strain (RVGLS) in patients with Ebstein anomaly. OBJECTIVES: This study sought to assess the relationship between RVGLS and mortality and to compare prognostic performance of RVGLS with conventional echocardiographic indices of right ventricular (RV) systolic function. METHODS: This study identified adults with Ebstein anomaly with echocardiographic assessment of RV systolic function (RVGLS, RV fractional area change [RVFAC], RV tissue Doppler systolic velocity [RV s'], and tricuspid annular plane systolic excursion [TAPSE]) from 2003 to 2020. For ease of presentation, RVGLS was modeled as absolute values (ie, without the negative sign). RESULTS: Of 620 patients (median age 37 years; men 261 [42%]), the mean absolute RVGLS, RVFAC, RV s', and TAPSE were 18% ± 5%, 32% ± 9%, 14 ± 6 cm/s, and 22 ± 8 mm, respectively. There were correlations between absolute RVGLS and RVFAC (r = 0.71; P < 0.001), between absolute RVGLS and RV s' (r = 0.41; P = 0.03), and between absolute RVGLS and TAPSE (r = 0.44; P = 0.002). Of 620 patients, 47 (8%) died during follow-up, and 34 of these deaths were cardiovascular. Absolute RVGLS was independently associated with all-cause mortality (adjusted HR: 0.94; 95% CI: 0.92-0.96 per unit increase) and cardiovascular mortality (adjusted HR: 0.92; 95% CI: 0.90-0.94 per unit increase). Absolute RVGLS had superior prognostic power (ie, ability to predict mortality) as compared with RVFAC, RV s', or TAPSE. CONCLUSIONS: These data support the use of RVGLS for risk stratification in Ebstein anomaly, and further studies are required to assess how interventions may affect different patients according to risk stratification.