International journal of cardiology · 2026
Central aortic pressure and LV remodeling after surgical versus transcatheter repair of coarctation of aorta: Prospective data from the MACHD-biobank.
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Egbe Alexander C, Miranda William R, Connolly Heidi M, Anderson Jason H, Dearani Joseph A, Reddy Yogesh N V, Borlaug Barry A
Аннотация
BACKGROUND: The purpose of this study was to compare central hemodynamics, arterial function, left ventricular (LV) indices, and cardiovascular biomarkers between patients with surgical versus transcatheter coarctation of aorta (COA) repair.
METHOD: Prospective study of adults with repaired COA enrolled in the MACHD-Biobank Registry (2019-2024). COA patients and normal controls underwent arterial function assessment, echocardiography, cardiac magnetic resonance imaging, and cardiovascular biomarker assay using a standardized protocol. COA patients were classified into surgical repair (COA_SR) versus transcatheter repair (COA_TR) group.
RESULTS: We enrolled 96 COA patients (COA_SR [N = 62,65%] and COA_TR [N = 34,35%]) and 78 controls. All aortic indices, LV indices and biomarkers of fibrosis were worse in COA patients compared to controls. COA_TR group had higher aortic stiffness (aortic pulse wave velocity: 7.92 ± 1.28 versus 7.15 ± 1.34 m/s, p = 0.005), central systolic blood pressure (SBP) (119 ± 11 versus 112 ± 12 mmHg, p = 0.02), and wave reflection (augmentation index 28 ± 13 versus 22 ± 10, p = 0.009) but similar brachial SBP compared to COA_SR group. COA_TR group had higher LV mass index (85 ± 21 versus 76 ± 19 g/m2, p = 0.007), worse LV global longitudinal strain (-19 ± 3% versus -21 ± 3%, p = 0.02), and greater extracellular matrix remodeling compared to the COA_SR group. Higher aortic stiffness and wave reflection correlated with higher central SBP, while higher central SBP correlated with LV hypertrophy.
CONCLUSIONS: Further studies are required to determine whether these observed differences central aortic hemodynamics and LV remodeling translate to differences in outcomes. There is also a need for a new paradigm for detection and management of central aortic hypertension in repaired COA.
CLINICAL SUMMARY: Of 96 patients with repaired COA enrolled in the MACHD-Biobank Registry, 62 (65%) underwent surgical repair (COA_SR) while 34 (35%) underwent transcatheter repair (COA_TR) group. The COA_TR group had higher central SBP, worse arterial function (higher aortic stiffness and wave reflection), worse LV remodeling (higher LVMI and lower LVGLS), and higher cardiovascular biomarkers of extracellular matrix remodeling compared to the COA_SR group. Higher aortic stiffness and wave reflection correlated with higher central SBP, while higher central SBP correlated with LV hypertrophy.
METHOD: Prospective study of adults with repaired COA enrolled in the MACHD-Biobank Registry (2019-2024). COA patients and normal controls underwent arterial function assessment, echocardiography, cardiac magnetic resonance imaging, and cardiovascular biomarker assay using a standardized protocol. COA patients were classified into surgical repair (COA_SR) versus transcatheter repair (COA_TR) group.
RESULTS: We enrolled 96 COA patients (COA_SR [N = 62,65%] and COA_TR [N = 34,35%]) and 78 controls. All aortic indices, LV indices and biomarkers of fibrosis were worse in COA patients compared to controls. COA_TR group had higher aortic stiffness (aortic pulse wave velocity: 7.92 ± 1.28 versus 7.15 ± 1.34 m/s, p = 0.005), central systolic blood pressure (SBP) (119 ± 11 versus 112 ± 12 mmHg, p = 0.02), and wave reflection (augmentation index 28 ± 13 versus 22 ± 10, p = 0.009) but similar brachial SBP compared to COA_SR group. COA_TR group had higher LV mass index (85 ± 21 versus 76 ± 19 g/m2, p = 0.007), worse LV global longitudinal strain (-19 ± 3% versus -21 ± 3%, p = 0.02), and greater extracellular matrix remodeling compared to the COA_SR group. Higher aortic stiffness and wave reflection correlated with higher central SBP, while higher central SBP correlated with LV hypertrophy.
CONCLUSIONS: Further studies are required to determine whether these observed differences central aortic hemodynamics and LV remodeling translate to differences in outcomes. There is also a need for a new paradigm for detection and management of central aortic hypertension in repaired COA.
CLINICAL SUMMARY: Of 96 patients with repaired COA enrolled in the MACHD-Biobank Registry, 62 (65%) underwent surgical repair (COA_SR) while 34 (35%) underwent transcatheter repair (COA_TR) group. The COA_TR group had higher central SBP, worse arterial function (higher aortic stiffness and wave reflection), worse LV remodeling (higher LVMI and lower LVGLS), and higher cardiovascular biomarkers of extracellular matrix remodeling compared to the COA_SR group. Higher aortic stiffness and wave reflection correlated with higher central SBP, while higher central SBP correlated with LV hypertrophy.