Impact of repaired aortic coarctation in left ventricular myocardial work

Myocardial strain analysis enables more precise assessment of cardiac performance but is relatively load dependent. New tools have been developed with afterload adjustment. Our objective was to assess myocardial work (MW) in patients with repaired aortic coarctation (rACo). Prospective study of consecutive patients with rACo who underwent a routine transthoracic echocardiogram in 2018 and 2019 at our center. Patients with significant aortic valve disease, pacemaker, or other congenital heart diseases (except for mild bicuspid aortic valve disease) were excluded. Global longitudinal strain with two dimensional speckle tracking analysis and MW were obtained (GWI:Global Work Index; GCW: Global Constructive Work; GWW: Global Wasted Work; GWE: Global Work Efficiency). Blood pressure was measured in the patient's right arm. We included 42 patients in the analysis, mean age of 37±10 years, 38% males. In this group, 52% had hypertension and 64% had a concomitant bicuspid aortic valve. In comparison to previously published reference values, patients with rACo had significantly lower GWI (1807 vs. 1896 mmHg%) and GCW (2173 vs. 2232 mmHg%) (p0.594). Neither age nor gender were independent predictors. In patients with rACo, there are some signs of left ventricular dysfunction with a reduction in GCW and GWI and with preserved GWE, despite normal ejection fraction and strain. O strain miocárdico permite uma avaliação mais precisa da função cardíaca, mas é relativamente dependente da carga. Existem novas ferramentas para ajuste da pós-carga. É nosso objetivo avaliar o trabalho miocárdico (TM) em doentes com coartação da aorta tratada (rCAo). Estudo prospetivo de doentes consecutivos com rCAo submetidos a ecocardiograma transtorácico de rotina em 2018 e 2019 no nosso centro. Doentes com doença valvular aórtica significativa, pacemaker ou outras cardiopatias congénitas (com exceção de doença valvular aórtica bicúspide ligeira) foram excluídos. Analisou-se o strain global longitudinal por speckle-tracking e obtido o TM (Índice trabalho global - GWI, Trabalho construtivo global - GCW, Trabalho desperdiçado global - GWW - e Eficiência do trabalho global - GWE). A pressão arterial foi avaliada simultaneamente. Incluímos 42 doentes, com 37 ± 10 anos, 38% do sexo masculino. Destes, 52% eram hipertens