Exercise stress echocardiography in repaired coarctation of the aorta

Abstract

Background: Exercise stress echocardiography is a helpful tool for haemodynamic evaluation and follow-up of patients with repaired coarctation of the aorta.

Aim: To determine if exercise stress echocardiography variables are predictive of reintervention (angioplasty or surgery).

Methods: We retrospectively reviewed 81 exercise stress echocardiograms performed in children (n=9) and adults with repaired coarctation of the aorta in three centres in France.

Results: The median age was 28.2 years (range 12-72 years). Twelve patients had a reintervention (14.8%). Forty-five patients (55.6%) had simple coarctation of the aorta, and 36 (44.4%) had complex anatomy. More than one third of patients had hypertension. Poor left ventricular adaptation to effort was present in 13 patients (16.1%). The mean peak isthmus systolic gradient was 48.4±19.7mmHg (range 15-124mmHg). Poor left ventricular adaptation was associated with more interventions (log-rank P=1×10^-5). On univariate analysis, the presence of antihypertensive drugs (hazard ratio 3.98, 95% confidence interval 1.15-13.82; P=0.030), previously stented coarctation of the aorta (hazard ratio 7.87, 95% confidence interval 2.19-28.31; P=0.002), lower exercise power (in Watts) (hazard ratio 0.98, 95% confidence interval 0.97-0.99; P=0.016) and peak isthmus systolic gradient at rest and on effort (hazard ratio 1.05, 95% confidence interval 1.01-1.09 [P=0.016] and hazard ratio 1.04, 95% confidence interval 1.01-1.06 [P=0.004], respectively) were significantly predictive of intervention. On multivariable analysis, lower left ventricular adaptation and peak isthmus systolic gradient at effort were associated with outcome (hazard ratio 10.73, 95% confidence interval 2.83-40.70 [P=0.000488] and hazard ratio 1.04, 95% confidence interval 1.01-1.07 [P=0.00835], respectively).

Conclusions: Exercise stress echocardiography can be useful for haemodynamic evaluation of patients with repaired coarctation of the aorta. Patients with less adaptation of the left ventricle to exercise and higher peak systolic gradient at isthmus may be candidates for reintervention.

Keywords: Exercise stress echocardiography; Repaired coarctation of the aorta.