Mechanical deformation in adult patients with unrepaired aortic coarctation

  • Leonel Avendaño-Pérez
  • María Elena Soto
  • Nydia Ávila-Vanzzini
  • Guillermo Bracamontes-Castelo
  • José Carlos Ruán-Díaz
  • Erick Alexanderson-Rosas
  • Nilda Espinola-Zavaleta
Original Paper


Aortic coarctation is a congenital heart disease that causes an increased left ventricular afterload, resulting in increased systolic parietal tension, compensatory hypertrophy, and left ventricular systolic and diastolic dysfunction. The speckle tracking is a new echocardiographic technique that allows the detection of subclinic left ventricular systolic dysfunction. The aim of this study was to detect early left ventricular dysfunction using mechanical deformation by echocardiography in adults with un-repaired aortic coarctation. A total of 41 subjects were studied, 20 patients with aortic coarctation and 21 control subjects, 21 women (51.2%), with an average age of 30 ± 10 years. All patients with aortic coarctation had systemic arterial hypertension (p < 0.001). Seventy percent (14/20) of the patients had bicuspid aortic valve. Statistically significance (p < 0.005) were found in left ventricular mass index, E/e ratio, pulmonary artery systolic pressure and peak velocity and maximum gradient of the aortic valve. The global longitudinal deformation of the left ventricle in patients with aortic coarctation was significative decreased, p < 0.001. The ejection fraction and the global longitudinal deformation of the left ventricle were significantly lower in patients with aortic coarctation compared to the control group, p < 0.003, p < 0.001, respectively. The subgroup of patients with coarctation and left ventricular ejection fraction < 55% had a marked decrease in global longitudinal strain (− 15.9 ± 4%). The radial deformation was increased in patients with aortic coarctation and showed a trend to be significant (r = 0.421; p < 0.06). A significant negative correlation was observed between the global longitudinal deformation and left ventricular mass index (r = 0.54; p = 0.01) in the aortic coarctation group. The patients with aortic coarctation and left ventricular hypertrophy had marked reduction of left ventricular global longitudinal deformation (− 16%, p < 0.05). In our study patients with normal left ventricular ejection fraction had abnormal global longitudinal deformation and also the increased left ventricular mass was related with a decreased left ventricular global longitudinal deformation as a sign of subclinical systolic dysfunction.


Aortic coarctation Mechanical deformation Congenital heart disease Speckle tracking 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Erbel R, Aboyans V, Boileau C, Holger E, Eggebrecht E, Bossone R, Bartolomeo R (2014) ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014:2914–2915Google Scholar
  2. 2.
    Kenny D, Hijazi ZM (2011) Coarctation of the aorta: from fetal life to adulthood. Cardiol J 18:487–495CrossRefPubMedGoogle Scholar
  3. 3.
    Smith DE, Matthews MB (1955) Aortic valvular stenosis with coarctation of the aorta, with special reference to the development of aortic stenosis upon congenital bicuspid valves. Br Heart J 17:198–206CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Becker AE, Becker MJ, Edwards JE (1970) Anomalies associated with coarctation of aorta: particular reference to infancy. Circulation 41:1067–1075CrossRefPubMedGoogle Scholar
  5. 5.
    Kimura-Hayama ET, Meléndez G, Mendizábal AL, Meave-González A, Zambrana GF, Corona-Villalobos CP (2010) Uncommon congenital and acquired aortic diseases: role of multidetector CT angiography. Radio Graphics 30:79–98Google Scholar
  6. 6.
    Hughes D Jr, Siegel MJ (2010) Computed tomography of adult congenital heart disease. Radiol Clin North Am 48:817–835CrossRefPubMedGoogle Scholar
  7. 7.
    Kirklin JW, Barrat-Boyes BG (1993) Coarctation of the aorta and interrupted aortic arch. In: Kirklin JW, Barrat-Boyes BG (eds) Cardiac surgery, 2nd edn, Churchill Livingstone, New York, pp 1263–1325Google Scholar
  8. 8.
    Castaneda AR, Jonas RA, Mayer JE Jr, Hanley FL (1994) Aortic coarctation in cardiac surgery of the neonate and infant. Saunders, Philadelphia, pp 333–352Google Scholar
  9. 9.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39CrossRefPubMedGoogle Scholar
  10. 10.
    Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein LA, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD (2016) CME test for Recommendations for the evaluation of left ventricular diastolic function in echocardiography. J Am Soc Echocardiogr 29:277–314CrossRefPubMedGoogle Scholar
  11. 11.
    Mor-Avi V, Lang R, Badano L, Belohlavek M, Cardim N, Derumeaux G, Galderisi M, Marwick T, Nagueh S, Sengupta P, Sicari R, Smiseth O, Smulevitz B, Takeuchi M, Thomas J, Vannan M, Voigt J, Zamorano J (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE Consensus statement on methodology and indications. J Am Soc Echocardiogr 24:277–313CrossRefPubMedGoogle Scholar
  12. 12.
    Thomas JD, Popovic´ZB (2006) Assessment of left ventricular function by cardiac ultrasound. J Am Coll Cardiol 48:2012–2025CrossRefPubMedGoogle Scholar
  13. 13.
    Menting M, van Grootel R, van den Bosch A, Eindhoven J, McGhie J, Cuypers J, Witsenburg M, Helbing W, Roos-Hesselink J (2016) Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation. Intern J Cardiovasc Imaging 32:777–787CrossRefGoogle Scholar
  14. 14.
    Helske S, Kupari M, Lindstedt KA, Kovanen PT (2007) Aortic valve stenosis: an active atheroinflamatory process. Curr Opin Lipidol 18:483–491CrossRefPubMedGoogle Scholar
  15. 15.
    Jashari H, Rydberg A, Ibrahimi P, Bajraktari G, Henein MY (2015) Left ventricular response to pressure afterload in children: aortic stenosis and coarctation. A systematic review of the current evidence. Intern J Cardiol 178:203–209CrossRefGoogle Scholar
  16. 16.
    Kowalik E, Kowalski M, Klisiewicz A, Hoffman P (2016) Global area strain is a sensitive marker of subendocardial damage in adults after optimal repair of aortic coarctation: three-dimensional speckle-tracking echocardiography data. Heart Vessels 31:1790–1797CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2017

Authors and Affiliations

  • Leonel Avendaño-Pérez
    • 1
  • María Elena Soto
    • 2
  • Nydia Ávila-Vanzzini
    • 3
  • Guillermo Bracamontes-Castelo
    • 1
  • José Carlos Ruán-Díaz
    • 1
  • Erick Alexanderson-Rosas
    • 4
  • Nilda Espinola-Zavaleta
    • 1
  1. 1.Laboratory of Echocardiography and Non-invasive HemodynamicsNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
  2. 2.Department ImmunologyNational Institute of Cardiology “Ignacio Chavez”Mexico CityMexico
  3. 3.Department of Out-patients ClinicNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
  4. 4.Department of Nuclear MedicineNational Institute of Cardiology “Ignacio Chavez”Mexico CityMexico

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