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Assessment of ventriculo-vascular properties in repaired coarctation using cardiac magnetic resonance-derived aortic, left atrial and left ventricular strain

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Abstract

Objectives

In patients with repaired coarctation of aorta (CoA), we assessed ventriculo-vascular characteristics using CMR-derived aortic area strain (AAS), left atrial (LA) and left ventricular (LV) longitudinal and circumferential strain (LS, CS).

Methods

Seventy-five subjects including 50 with repaired CoA divided into hypertensive (n = 25), normotensive (n = 25) and 25 controls were studied. AAS was measured at 3 levels: ascending aorta, proximal descending and descending aorta. LA and LV LS were measured using CMR-feature tracking. LA and LV end-diastolic volumes, ejection fraction (EF) and mass were measured.

Results

Mean patient age was 19.7 ± 6.7 and controls 23 ± 15 (years). All strains (LA, LV, ascending and descending aortic) were lower in CoA subgroups compared to controls except the AAS at diaphragm, which was not different. Comparisons between hypertensive and normotensive CoA showed no differences in LV mass, LV volumetric indices, and LA and LV strain indices; however, ascending AAS was lower in hypertensive subgroup (p = 0.02). Ascending AAS was correlated with LV mass (r = −0.4, p = 0.005), LVEF (r = −0.4, p = 0.004), systolic blood pressure (r = −0.5, p = 0.0001) and LVLS (r = 0.5, p = 0.001).

Conclusions

Ascending AAS correlated with LV mass, EF and LVLS. In hypertensive CoA, ascending AAS was reduced compared to normotensive CoA and controls, indicating vascular remodelling differences influenced by ongoing hypertension.

Key Points

• Impaired arterial strain is a measure of increased stiffness in arteries

• Ascending aorta strain correlates with left ventricular mass and longitudinal strain

• Ascending aorta strain is significantly lower in hypertensive coarctation patients

• Hypertension may be a consequence of vascular pathology persisting despite repair

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Abbreviations

AAS:

Aortic area strain

AAAS:

Ascending aortic area strain

BSA:

Body surface area

CoA:

Coarctation of the aorta

CHD:

Congenital heart disease

CMR-FT:

Cardiac magnetic resonance-feature tracking

DAAS:

Descending aortic area strain

DBP:

Diastolic blood pressure

DDAAS:

Distal descending aortic area strain

EDVi:

Indexed end-diastolic volume

EF:

Ejection fraction

HT:

Hypertensive

LA:

Left atrium

LALS:

LA longitudinal strain

LV:

Left ventricle

LVCS:

LV circumferential strain

LVLS:

LV longitudinal strain

LV mass i:

Indexed LV mass

NT:

Normotensive

SBP:

Systolic blood pressure

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Acknowledgments

The authors appreciate the assistance of the Magnetic Resonance Imaging Laboratory staff at the Children’s Hospital and Medical Center. We also thank Berthold Klas, BS, TomTec Imaging Systems, TomTec Corporation USA for technical assistance.

The scientific guarantor of this publication is Shelby Kutty. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. Shelby Kutty has received support from the American Heart Association and Children’s Hospital and Medical Center Foundation. David Danford kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written consent was waived because this was a retrospective study. Approval from the institutional animal care committee was not required because this is a human study. None of the study subjects or cohorts have been previously reported. Methodology: retrospective, case-control study, multicentre study.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, 8200, Dodge Street, Omaha, NE, 68114, USA

    Quanliang Shang, Shivani Patel, David A. Danford & Shelby Kutty

  2. Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China

    Quanliang Shang

  3. Hannover Medical School, Hannover, Germany

    Samir Sarikouch & Philipp Beerbaum

  4. Department of Cardiology and Pneumonology, Georg-August-University and German Center for Cardiovascular Research (DZHK, Partner Site), Göttingen, Germany

    Andreas Schuster

  5. Department of Pediatric Cardiology, Georg-August-University and German Center for Cardiovascular Research (DZHK, Partner Site), Göttingen, Germany

    Michael Steinmetz

  6. University Paris Diderot, Department of Radiology, Hospital Bichat, APHP, Paris, France

    Phalla Ou

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  1. Quanliang Shang
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  2. Samir Sarikouch
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  9. Shelby Kutty
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Correspondence to Shelby Kutty.

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Shang, Q., Sarikouch, S., Patel, S. et al. Assessment of ventriculo-vascular properties in repaired coarctation using cardiac magnetic resonance-derived aortic, left atrial and left ventricular strain. Eur Radiol 27, 167–177 (2017). https://doi.org/10.1007/s00330-016-4373-8

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  • DOI: https://doi.org/10.1007/s00330-016-4373-8

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