Portal de Periódicos da CAPES

Letter by Buttice and Ahmad Regarding Article, “Right Heart Dysfunction in Adults With Coarctation of Aorta: Prevalence and Prognostic Implications”

2022; Lippincott Williams & Wilkins; Volume: 15; Issue: 3 Linguagem: Inglês

10.1161/circimaging.122.013971

1942-0080

Leonardo Buttice, Mahmood Ahmad,

Aortic Disease and Treatment Approaches

HomeCirculation: Cardiovascular ImagingVol. 15, No. 3Letter by Buttice and Ahmad Regarding Article, "Right Heart Dysfunction in Adults With Coarctation of Aorta: Prevalence and Prognostic Implications" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessLetterPDF/EPUBLetter by Buttice and Ahmad Regarding Article, "Right Heart Dysfunction in Adults With Coarctation of Aorta: Prevalence and Prognostic Implications" Leonardo Buttice, BSc and Mahmood Ahmad, MBBS Leonardo ButticeLeonardo Buttice Correspondence to: Leonardo Buttice, iBSc, Flat 2, Kingston House, 24 Fortess Rd, London NW5 2EX, United Kingdom. Email E-mail Address: [email protected] https://orcid.org/0000-0003-3527-2172 University College London (UCL), United Kingdom (L.B.). and Mahmood AhmadMahmood Ahmad Tahir Heart Institute, Rabwah, Pakistan (M.A.). Originally published23 Feb 2022https://doi.org/10.1161/CIRCIMAGING.122.013971Circulation: Cardiovascular Imaging. 2022;15Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: February 23, 2022: Ahead of Print To the EditorEgbe et al1 wrote an interesting article investigating the use of a novel prognostic tool where right heart function and hemodynamics are used to assess the risk of cardiovascular events in patients with coarctation of aorta (COA). It was found that the right heart hemodynamic score, which is based on 7 right heart indices, such as right ventricular global longitudinal strain, was independently associated with cardiovascular events, demonstrating the prognostic implications this tool may provide in the clinical setting by risk stratifying patients with COA.Meijs et al2 conducted a prospective cohort study that identified that an elevated left ventricular mass index is strongly associated with an increased risk of cardiovascular events in patients with repaired COA, indicating its prognostic value. An increased left ventricular mass likely correlates with diastolic dysfunction and thus right heart failure. The study also uses a patient population with similar baseline characteristics to the study by Egbe et al.1 Therefore, it may be useful in future studies for Egbe et al to include left ventricular mass as an additional tool alongside the right heart hemodynamic score.Furthermore, Hlebowicz et al3 identified that patients with previous COA repair develop more atherosclerosis in the carotid arteries than is expected. This may contribute to an increased diastolic pressure leading to dysfunction and potentially right heart failure. It remains unclear why atherosclerosis is accelerated in these patients but Hlebowicz et al3 suggest it may be due to dysregulated apoptosis and repair mechanisms mediated by molecules such as monocyte chemoattractant protein-1. Although coronary artery disease was not independently associated with incident cardiovascular events in the multivariable Cox model assessed by Egbe et al,1 it may be of interest to compare the levels of carotid atherosclerosis in patients with COA to controls in future studies to better understand its value as a marker of cardiovascular event risk or as a target for future therapies.Lastly, Mandell et al4 found, using 4-dimensional flow cardiovascular magnetic resonance, that patients with previously repaired COA have altered secondary flow characteristics such as vorticity and helicity which directly correlate with the impaired exercise capacity that patients with COA experience. It was also found that simple pressure gradients measured across the aorta do not correlate with exercise capacity and mask the altered hemodynamics which may contribute to diastolic dysfunction. Egbe et al1 mentions that there is no correlation between COA mean gradient and right heart indices. Instead, measuring vorticity and helicity using 4-dimensional cardiovascular magnetic resonance may give a more accurate insight into the relationship between the altered hemodynamics and right heart failure in patients with COA.The use of the right heart hemodynamic score as a prognostic tool has demonstrated great potential for use in the clinical setting and Egbe et al1 should be commended for their excellent work. However, recent research has made it apparent that the mechanisms responsible for the increased prevalence of cardiovascular events in patients with COA may be more complicated than originally understood and further study is required to identify the most appropriate prognostic markers and targets for intervention.Disclosures None.FootnotesFor Disclosures, see page 197.Correspondence to: Leonardo Buttice, iBSc, Flat 2, Kingston House, 24 Fortess Rd, London NW5 2EX, United Kingdom. Email leonardo.buttice.[email protected]ac.ukReferences1. Egbe AC, Miranda WR, Jain CC, Connolly HM. Right heart dysfunction in adults with coarctation of aorta: prevalence and prognostic implications.Circ Cardiovasc Imaging. 2021; 14:1100–1108. doi: 10.1161/CIRCIMAGING.121.013075LinkGoogle Scholar2. Meijs TA, Minderhoud SCS, Muller SA, de Winter RJ, Mulder BJM, van Melle JP, Hoendermis ES, van Dijk APJ, Zuithoff NPA, Krings GJ, et al.. Cardiovascular morbidity and mortality in adult patients with repaired aortic coarctation.J Am Heart Assoc. 2021; 10:e023199. doi: 10.1161/JAHA.121.023199LinkGoogle Scholar3. Hlebowicz J, Holm J, Lindstedt S, Goncalves I, Nilsson J. Carotid atherosclerosis, changes in tissue remodeling and repair in patients with aortic coarctation.Atherosclerosis. 2021; 335:47–52. doi: 10.1016/j.atherosclerosis.2021.09.016CrossrefMedlineGoogle Scholar4. Mandell JG, Loke YH, Mass PN, Cleveland V, Delaney M, Opfermann J, Aslan S, Krieger A, Hibino N, Olivieri LJ. Altered hemodynamics by 4D flow cardiovascular magnetic resonance predict exercise intolerance in repaired coarctation of the aorta: an in vitro study.J Cardiovasc Magn Reson. 2021; 23:99. doi: 10.1186/s12968-021-00796-3CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails March 2022Vol 15, Issue 3Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.122.013971PMID: 35290078 Originally publishedFebruary 23, 2022 PDF download Advertisement