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.