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Right Ventricular Strain Impairment in Adults and Adolescents with Repaired Aortic Coarctation

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Abstract

This study examines the function of the right ventricle (RV) using two-dimensional (2D) strain analysis after aortic coarctation (CoA) repair, as well as relationships between potential RV strain abnormalities and patient characteristics. The study examined 39 patients (61% male, age 32 ± 16 years) with CoA repair (33 post end-to-end anastomosis/sub-clavian flap, 6 post stenting/bypass/Teflon patch) and 42 controls. The structure and function of the left ventricle (LV), left atrium (LA), and RV were assessed using 2D standard echocardiography, tissue Doppler imaging, and 2D strain imaging. The characteristics examined included global RV longitudinal strain (RV-GLS), global LV longitudinal strain (LV-GLS), and LA longitudinal strain (LA strain). RV dysfunction was defined by RV-GLS lower than the mean minus 2 standard deviations (SDs) of the control group value. LV mass and mitral E/Ea were significantly higher in the CoA group. Septal Ea, LV-GLS, and LA strain were significantly lower in the CoA group. RV dysfunction (RV-GLS >  − 16%) was present in 10 (25.6%) CoA patients. RV-GLS was correlated with lateral Ea, LV-GLS, and LA strain (r =  − 0.35, p = 0.02; r =  − 0.54, p < 0.001; and r =  − 0.44, p = 0.005, respectively). Patients who had a stenting/bypass/Teflon patch as the first initial repair exhibited significantly lower RV-GLS. RV systolic strain abnormalities may occur in patients late after CoA repair. RV strain was correlated with parameters of LV dysfunction. Further large-scale studies are required to confirm these findings and to determine the mechanisms and prognostic implications of RV strain in such patients.

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Abbreviations

ACE:

Angiotensin converting enzyme

BMI:

Body mass index

CoA:

Coarctation

HFpEF:

Heart failure with preserved ejection fraction

E′:

Tricuspid annular diastolic peak velocity by TDI

ET:

Ejection time

ICC:

Intra class correlation

LA:

Left atrial

LV:

Left ventricle

RV-GLS:

Global right ventricular longitudinal strain

LV-GLS:

Global left ventricular longitudinal strain

MPI:

Myocardial performance index

MRI:

Magnetic resonance imaging

TDI:

Tissue Doppler imaging

2D:

Two dimensional

PH:

Pulmonary hypertension

RA:

Right atrial

RVOT:

Right ventricular outflow tract

RAAS:

Renin–angiotensin–aldosterone system

S′:

Annular tricuspid systolic peak velocity by tissue Doppler imaging

SD:

Standard deviation

SPAP:

Systolic pulmonary artery pressure

TAPSE:

Tricuspid annular plane systolic excursion

TCO:

Tricuspid closure opening time

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Authors and Affiliations

  1. Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France

    Fabien Labombarda, Laurine Verdier, Pascale Maragnes, Paul Milliez & Farzin Beygui

  2. Université Caen Normandie, Medical School, UNICAEN, CHU Caen, EA, 4650, Signalisation, électrophysiologie Et Imagerie Des lésions D’ischémie-Reperfusion Myocardique, 14000, Caen, France

    Fabien Labombarda, Paul Milliez & Farzin Beygui

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  1. Fabien Labombarda
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  2. Laurine Verdier
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  3. Pascale Maragnes
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  4. Paul Milliez
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Contributions

FL: concept, data collection, data interpretation, statistics, drafting article, approval of article. LV: data collection, data analysis, approval of article. PM: data collection, critical revision and approval of article. PM: Critical revision and approval of article. FB: data interpretation, critical revision and approval of article.

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Correspondence to Fabien Labombarda.

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Labombarda, F., Verdier, L., Maragnes, P. et al. Right Ventricular Strain Impairment in Adults and Adolescents with Repaired Aortic Coarctation. Pediatr Cardiol 41, 827–836 (2020). https://doi.org/10.1007/s00246-020-02320-3

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  • DOI: https://doi.org/10.1007/s00246-020-02320-3

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