4. DISCUSSION
In this study, we shown that 2D-STE total strain analysis of patients
with CoA did not differ from the
healthy controls. Only the A2C basal inferior and basal anterior and A3C
mid inferolateral regions had local deterioration. The circumferential
strain was normal. Like many other study; we showed normal total global
LV function in patients who underwent CoA repair many years earlier and
who had blood pressure control.13,14 Kowalski et al.
also showed normal global LV function and LV longitudinal strain in CoA
patients using 2D-STE, suggesting only the anterior LV walls were
impaired.15 In another study, patients with
ventricular outflow tract stenosis (with CoA and aortic stenosis) made
an 2D-STE preoperatively and postoperatively, and there was a marked
improvement in both groups.16 Postoperative
improvement was considered better in the group operated for CoA between
the two groups. In this study, the follow-up period was 18 months and
the mean follow-up period of our patients was 3.74 ± 2.3 years. This
study has no long-term results, but the future results of our study may
be similar to those of Kowalski et al.
We determined that 2D-STE parameters were lower in the hypertensive CoA
subgroup compared to the normotensive CoA subgroup. One of the most
important problems for these patients following the operation is
hypertension. According to 26 articles published between 1987 and 2012,
hypertension remains a common complication following aortic coarctation
repair was found to be 32.5% (range 25-68%).17Kowalik et al. evaluated 26 cases patients with CoA that underwent
operation with three dimensional speckle-tracking echocardiography D-STE
and, despite preservation of the EF, the global strain measurement was
found to be decreased compared with controls.18Similar to our study, they observed that the total global strain
decreased as the mean blood pressure increased. A meta-analysis LV
global longitudinal strain in healthy cases showed that only blood
pressure was independently associated with strain
values.19
In contrast to our study, Florianczyk et al. compared global
longitudinal strain in a healthy group with tissue Doppler strain
analysis higher than in operated for CoA.20 There were
no significant differences in global longitudinal strain between the
hypertensive CoA group and the normotensive CoA group. In our patients,
we found the global longitudinal strain analyses to be impaired in the
hypertensive CoA subgroup. We thought that this difference may be caused
by the higher number of patients with hypertension in our study. In
contrast, Menting et al. showed that LV dysfunction, which cannot be
detected by M mod echocardiography, deteriorated in the late period
after CoA repair with 2D-STE and LV global longitudinal
strain.21 In their study, there were additional
diseases, such as aortic insufficiency and valve replacement, which
impair LV function.
Kutty et al. showed that global longitudinal strain reduction is more
pronounced in the presence of LV hypertrophy.22 Our
patients did not have LV hypertrophy and there was no reduction in
global longitudinal strain. Shang et al. reported increased LVM and
decreased myocardial deformation in hypertensive CoA patients compared
to healthy controls.23 According to Salva et al.,
2D-STE analysis on obese and lean young patients revealed abnormal
myocardial deformation properties along longitudinal, radial, and
circumferential planes in the obese CoA patients.24However, there was no obesity among our patients.
Impaired global strain was shown after CoA repair that correlated with
the systolic blood pressure, which matches our observations.