Factors associated with left ventricular hypertrophy in adults with surgically repaired coarctation of the aorta

Daniel Rinnström, Gunnar Engström, Martin Ugander, Bengt Johansson


Introduction: Most patients with repaired coarctation of the aorta (CoA) live normal lives and have good physical
performance. However, even after a successful surgical intervention, long-term cardiovascular risks including left ventricular
hypertrophy remain. The aim of the study was to identify factors associated with increased left ventricular mass (LVM) in
patients with surgically repaired CoA.
Methods: Consecutive cardiovascular magnetic resonance investigations in 51 patients with surgically repaired CoA (age
37+/-15 years, age at intervention 9.7 ± 6.8 years, 45% female) were reviewed. LVM was measured and indexed to body
surface area. The association between increased LVM index and clinical, anatomic and functional variables was investigated
with logistic regression analysis.
Results: In this population, 14/51 (27%) patients had a LVM index above normal limits. Factors associated with an increased
LVM index in univariate analysis were higher systolic blood pressure (odds ratio (OR) = 1.04, 95 % confidence interval
(CI) 1.00-1.08, p = 0.03), descending aortic diameter (OR = 1.48, CI 1.14-1.90, p = 0.003) and more than mild aortic valve
disease or previous aortic valve intervention (OR = 15.1, CI 2.50-48.4, p=0.002), but not diastolic blood pressure, diameter of
ascending aorta, diameter or ratio of CoA, velocity in descending aorta, smoking or bicuspid aortic valve (p > 0.05 for all). In
multivariate analysis, only systolic blood pressure (p = 0.05) and aortic valve disease (p = 0.006) remained significant, yielding
R2 = 0.47, p = 0.002 for the model.
Conclusion: Increased LVM is a common late finding after surgically repaired CoA. This study showed that LVM was
associated with modifiable factors; systolic blood pressure and aortic valve disease. As most patients are young, and
increased LVM will eventually affect ventricular function, close attention to blood pressure optimization may be of particular
importance in the surgically repaired CoA population.

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DOI: https://doi.org/10.17987/icfj.v1i2.25

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