Reverse Cardiac Remodeling Induced by Endovascular Treatment of Coarctation of the Aorta

BACKGROUND: Limited research has explored the transformation of echocardiographic parameters during mid- to long-term follow-up in patients with native coarctation of the aorta (CoA) managed through stenting. This study assesses changes in echocardiographic parameters among patients undergoing stent coarctoplasty, by comparing baseline and 3-year transthoracic echocardiographic (TTE) parameters. METHODS: In our earlier work, we detailed the 3-year clinical safety and efficacy outcomes of balloon-expandable versus self-expandable stents for treating native CoA within a randomized clinical trial. The current substudy aims to assess the mid-term effects of stenting by examining all participants with available baseline and 3-year core laboratory-confirmed TTE data. RESULTS: Of the 92 patients enrolled in the randomized trial, 32 individuals (median age: 32 years IQR: 24.8-37.5) were included in this substudy. At the 3-year follow-up, significant improvements were observed in myocardial diastolic function, characterized by increased septal E' and lateral E' velocities (p = 0.02 and p = 0.03, respectively) and decreased septal and lateral E/E' ratios (10.84 ± 2.83 to 9.21 ± 3.17, p = 0.02 and 7.39 ± 2.24 to 6.29 ± 1.97, p = 0.02, respectively). At the 3-year follow-up, a significant reduction in left ventricular (LV) mass was observed, decreasing from 160 g (IQR: 130-203) to 142 g (IQR: 121-172) (p = 0.001). Among the 12 patients (37.5%) presenting with baseline LV hypertrophy, nine individuals (75%) experienced normalization, demonstrating a substantial improvement in LV mass. Additionally, the prevalence of diastolic dysfunction significantly decreased from 12 patients (41.3%) to four patients (13.7%) at the 3-year evaluation. CONCLUSIONS: In adult patients with de novo native CoA, stent coarctoplasty was found to result in significant and sustained improvements in LV diastolic function and reduced LV mass during the mid-term follow-up. Our findings imply that baseline structural parameters may serve as stronger predictors of long-term therapeutic outcomes than demographic factors. TRAIL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20181022041406N3.