Abstract
BackgroundIn aortic coarctation, current guidelines recommend reducing pressure gradients that exceed given thresholds. From a physiological standpoint this should ideally improve the energy expenditure of the heart and thus prevent long term organ damage.ObjectivesThe aim was to assess the effects of interventional treatment on external and internal heart power (EHP, IHP) in patients with aortic coarctation and to explore the correlation of these parameters to pressure gradients obtained from heart catheterization.MethodsIn a collective of 52 patients with aortic coarctation 25 patients received stenting and/or balloon angioplasty, and 20 patients underwent MRI before and after an interventional treatment procedure. EHP and IHP were computed based on catheterization and MRI measurements. Along with the power efficiency these were combined in a cardiac energy profile.ResultsBy intervention, the catheter gradient was significantly reduced from 21.8±9.4 to 6.2±6.1mmHg (p<0.001). IHP was significantly reduced after intervention, from 8.03±5.2 to 4.37±2.13W (p < 0.001). EHP was 1.1±0.3 W before and 1.0±0.3W after intervention, p = 0.044. In patients initially presenting with IHP above 5W intervention resulted in a significant reduction in IHP from 10.99±4.74 W to 4.94±2.45W (p<0.001), and a subsequent increase in power efficiency from 14 to 26% (p = 0.005). No significant changes in IHP, EHP or power efficiency were observed in patients initially presenting with IHP < 5W.ConclusionIt was demonstrated that interventional treatment of coarctation resulted in a decrease in IHP. Pressure gradients, as the most widespread clinical parameters in coarctation, did not show any correlation to changes in EHP or IHP. This raises the question of whether they should be the main focus in coarctation interventions. Only patients with high IHP of above 5W showed improvement in IHP and power efficiency after the treatment procedure.Trial Registrationclinicaltrials.gov NCT02591940
Highlights
Differences in international guideline treatment criteria exist, decision making in coarctation of the aorta (CoA) is regularly based on pressure gradients [1, 2]
The aim was to assess the effects of interventional treatment on external and internal heart power (EHP, IHP) in patients with aortic coarctation and to explore the correlation of these parameters to pressure gradients obtained from heart catheterization
No significant changes in IHP, external heart power (EHP) or power efficiency were observed in patients initially presenting with IHP < 5W
Summary
Differences in international guideline treatment criteria exist, decision making in coarctation of the aorta (CoA) is regularly based on pressure gradients (pressure drops) [1, 2]. A more general goal in cardiologic interventions and surgical procedures is to optimize the energetical state of the heart muscle allowing the most efficient oxygen consumption of the myocardial tissue. This goal can usually be reached by optimization of the hemodynamic situation [3,4,5]. Current guidelines in CoA cannot address satisfactory methods of preventing long-term morbidity and mortality in treated patients, raising the question of whether the pressure gradient is a sufficient guide for energetical optimization in patients with CoA. From a physiological standpoint this should ideally improve the energy expenditure of the heart and prevent long term organ damage
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