Determinants and Prognostic Implications of Left Atrial Reverse Remodeling After Coarctation of Aorta Repair in Adults
Alexander C Egbe, Ahmed Younis, William R Miranda, C Charles Jain, Heidi M Connolly, Barry A Borlaug- Cardiology and Cardiovascular Medicine
- Radiology, Nuclear Medicine and imaging
- General Medicine
Abstract
Background
Left atrial (LA) dysfunction and atrial fibrillation are also relatively common in adults with coarctation of aorta (COA), and the severity of LA dysfunction is associated with higher risk of atrial fibrillation in this population. The purpose of this study was to determine whether LA function improved after COA repair (LA reverse remodeling), and the relationship between LA reverse remodeling and atrial fibrillation.
Method
Retrospective cohort study of adults undergoing COA repair (2003-2020). LA reservoir strain was assessed preintervention and 12-24 months postintervention, using speckle tracking echocardiography. Incident atrial fibrillation was assessed from COA repair to last follow-up.
Results
Of 261 adults that underwent COA repair (age 37 ± 13 years; males 148 [57%]), 124 (47%) and 137 (53%) presented with native versus recurrent COA, respectively. Of 261 patients, 231 (82%) and 48 (18%) underwent surgical and transcatheter COA repair, respectively. LA reservoir strain increased from 32 ± 8% (preintervention) to 39 ± 7% (post intervention), yielding a relative increase of 21 ± 5%. Older age (β±SE -0.16 ± 0.09 per 5-year, p = 0.02), higher systolic blood pressure (β±SE -0.12 ± 0.04 per 5 mmHg, p = 0.005), and higher residual COA mean gradient (β±SE -0.17 ± 0.06 per 5 mmHg, p = 0.002) postintervention were associated with less LA reverse remodeling, after adjustment for sex, hypertension diagnosis, and left ventricular indices. LA reverse remodeling (hazard ratio 0.97, 95% confidence interval 0.96-0.98 per 1% increase from preintervention LA function, p = 0.006) was associated with lower risk of atrial fibrillation after adjustment for age, sex, preintervention LA reservoir strain, and history of atrial fibrillation.
Conclusions
COA repair resulted in improved LA function and decreased risk for atrial fibrillation, especially in patients without residual hypertension or significant residual COA gradient.