Beyond Pressure Gradients: The Effects of Intervention on Heart Power in Aortic Coarctation.

PLoS One 2017 12;12(1):e0168487. Epub 2017 Jan 12.

Department of Congenital Heart Disease, German Heart Centre Berlin, Augustenburger Platz 1, Berlin, Germany.

Background: In 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.

Objectives: 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.

Methods: In 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.

Results: By 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.

Conclusion: It 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 Registration: clinicaltrials.gov NCT02591940.

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168487PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5231370PMC
August 2017
21 Reads

Publication Analysis

Top Keywords

aortic coarctation
16
pressure gradients
12
heart power
8
interventional treatment
8
patients aortic
8
ehp ihp
8
damageobjectives aim
4
aim assess
4
effects interventional
4
balloon angioplasty
4
angioplasty patients
4
assess effects
4
organ damageobjectives
4
patients underwent
4
underwent mri
4
procedure ehp
4
heart prevent
4
ihp computed
4
prevent long
4
treatment procedure
4

References

(Supplied by CrossRef)
Total Energy Expenditure of Infants with Congenital Heart Disease Who Have Undergone Surgical Intervention
JC Trabulsi et al.
Pediatric cardiology 2015
Miniinvasive interventional bridge to major surgical repair of critical aortic coarctation in a newborn with severe multiorgan failure
I Haponiuk et al.
Wideochir Inne Tech Malo Inwazyjne 2013
Acquired Post-Traumatic Aortic Coarctation Presenting as New-Onset Congestive Heart Failure: Treatment with Endovascular Repair
NB Thompson et al.
Ann Vasc Surg 2015
Adult's aortic coarctation and congestive heart failure
I Bravio et al.
Rev Port Cir Cardiotorac Vasc 2004
Long-term follow-up after aortic coarctation repair: the unsolved issue of exercise-induced hypertension
AS Correia et al.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 2013

Similar Publications