Heart rate and left ventricular remodeling after repaired coarctation of the aorta: a cross-sectional study

Figures

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  Fig. 1. Correlations of PWTd and IVSTd. PWTd and IVSTd exhibit significant positive correlations with CBP and PWV suggesting a link between increased arterial stiffness, central pressure and ventricular remodeling. In contrast, inverse associations were observed with the AIx@75 and HR. The negative trend with HR is apparent but did not reach statistical significance. PWTd, posterior wall thickness in diastole; IVSTd, interventricular septal thickness in diastole; CBP, central blood pressure; PWV, pulse wave velocity; AIx@75, heart rate–adjusted augmentation index; HR, heart rate.

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  Fig. 2. Effects of heart rate modulation on left ventricular remodeling. A computational simulation predicts that a 10% increase in HR, while keeping all other variables constant, reduces the posterior wall thickness diameter by 0.36 mm, leading to a decrease in prevalence from 30.1% (95% CI, 17.6, 47.1) to 5.1% (95% CI, 0.6, 18.1). HR, heart rate; CI, confidence interval. ***P < 0.001.

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  Fig. 3. Representative pulse wave analysis in 2 patients with different HRs. The arterial waveform (red) is composed of 2 main components: the forward wave (dashed line) and the reflected wave (dotted line). In the patient with a lower HR (68 bpm), the forward (P1) and reflected (P2) waves merge, blunting the typical waveform. In contrast, in the patient with a HR of 82 bpm, P1 and P2 are clearly separated, resulting in a higher AIx@75. These findings suggest that a higher HR shortens systole, shifting the reflected wave toward diastole and reducing early systolic load. Conversely, a lower HR prolongs systole, promoting earlier wave overlap and increasing left ventricular load. HR, heart rate; AIx, adjusted augmentation index.

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  Fig. 4. Schematic representation of the effect of heart rate on LV remodeling. In patients with repaired CoAo, lower heart rate prolongs systole, causing the reflected wave (P2) to arrive early and merge with the forward wave (P1). This reduces the visible augmentation index but increases systolic load, promoting ventricular remodeling. In contrast, higher heart rate shortens systole and shifts the reflected wave (P2) later in the cardiac cycle, separating it from P1. This increases AIx@75 but reduces effective ventricular load. LV, left ventricular; CoAo, coarctation of the aorta; AIx@75, heart rate–adjusted augmentation index.