Evaluation of arterial stiffness in patients with repaired coarctation of the aorta

Objective: Coarctation of the aorta (CoA) is a congenital heart disease in which arterial stiffness and the associated risk of cardiovascular complications may persist in the long term despite successful treatment. The aim of this study was to evaluate arterial stiffness in patients with repaired CoA, to investigate potential myocardial impairment using three-/four-dimensional (3D/4D) strain echocardiography, and to compare the findings with a healthy control group in order to elucidate the clinical significance of arterial stiffness. Materials and Methods: The study included 41 patients with repaired CoA who were followed at Gaziantep University Faculty of Medicine and 34 age- and sex-matched healthy individuals as controls. Arterial stiffness parameters were assessed using the Mobil-O-Graph device. All participants underwent standard two-dimensional (2D), M-mode, tissue Doppler, and 3D/4D strain echocardiography. Additionally, electrocardiography (ECG) was performed in the patient group. Statistical analyses were carried out using IBM SPSS Statistics version 27. Results: No significant difference was observed between groups in terms of age and sex distribution (p>0.05). Height was significantly lower in the patient group (p=0.033), whereas weight and body mass index were comparable (p>0.05). Pulse wave velocity values did not differ between groups; however, reflection magnitude (p=0.017) and augmentation index (p=0.004) were significantly higher in patients. Strain echocardiography parameters were similar in both groups (p>0.05). Left ventricular ejection fraction was comparable, whereas cardiac output was significantly reduced (p=0.012), and end-diastolic and end-systolic mass and their indexed values were significantly increased in patients (p<0.05). M-mode parameters were mostly similar, but EF (Teich) and fractional shortening were higher in the patient group (p=0.010 and p=0.008). Doppler analysis revealed higher mitral E and A wave velocities in patients, whereas the E/A ratio was significantly higher in controls (p=0.004). Among additional findings, bicuspid aortic valve was observed in 73.2% and left ventricular hypertrophy in 90.2% of patients. Persistent hypertension was present in 21.9%, and residual gradient was 23.0 ± 15.0 mmHg. Conclusion: In patients with repaired CoA, short stature, left ventricular hypertrophy, and vascular dysfunction remain prevalent compared with healthy controls. Although the prevalence of persistent hypertension was relatively low, lifelong blood pressure surveillance is warranted. The higher lower-extremity blood pressures compared to the upper extremities suggest improved perfusion following repair. These findings highlight the necessity of long-term multidisciplinary follow-up in CoA patients. Keywords: Coarctation of the aorta, arterial stiffness, pulse wave velocity, strain echocardiography.