Key result
Aortic isthmus ratio ≤0.7 strongly correlates with left ventricular hypertrophy and higher LVMI.
Why the study?
It is unclear how many COA severity indices are required to recommend intervention and their hierarchical importance in patients presenting with only some of these indices.
Cross-Sectional (n=811)
No
In adults with repaired coarctation of the aorta, the load-independent aortic isthmus ratio derived from cross-sectional imaging correlates more strongly with left ventricular hypertrophy than physiologic indices, suggesting a ratio of ≤0.7 is a superior and highly sensitive anatomic threshold for clinical risk stratification.
May support anatomic over physiologic indices for LVH assessment in repaired coarctation; leaves open prospective outcome validation.
Background: Coarctation of aorta (COA) results in chronic left ventricular (LV) pressure overload and LV hypertrophy, which is associated with cardiovascular mortality. Therapies that decrease LV pressure overload result in regression of LV hypertrophy and improved survival. The goal of COA intervention is to relieve LV pressure overload, and the guidelines recommend the use of several COA severity indices as indications for intervention. These indices are Doppler mean gradient, systolic blood pressure (SBP), upper-to-lower-extremity SBP (ULE-SBP), aortic isthmus ratio, presence of collateral vessels, and exercise-induced hypertension (EIH). Although these indices are physiologically intuitive, it is unclear how many of these indices are required in order to recommend intervention, and the hierarchical importance of the different indices in patients that have some but not all the indices. Methods: In this cross-sectional study, multivariate linear regression analysis was used to assess the correlation between LV mass index (LVMI) and indices of COA severity. Results: Of the COA indices analyzed in 811 adult with repaired COA patients, aortic isthmus ratio had the strongest correlation with LVMI (β coefficients ±standard error -31.6 ± 13.8, p < 0.001), as compared to Doppler peak gradient (0.79 ± 0.22, p = 0.002) and SBP (0.53 ± 0.21, p = 0.03). Conclusion: Aortic isthmus ratio had the strongest correlation with LVMI, which is a reflection of chronic LV pressure overload. An aortic isthmus ratio ≤0.7 was the optimal cut-off point to detect LV hypertrophy with good sensitivity and specificity. These results can potentially improve and simplify patient selection for COA intervention.
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Kholeif et al. (2025) conducted a cross-sectional in Repaired coarctation of aorta (COA) with left ventricular hypertrophy (n=811). Aortic isthmus ratio vs. Other COA severity indices (Doppler gradient, systolic blood pressure, ULE-SBP) was evaluated on Correlation between left ventricular mass index (LVMI) and aortic isthmus ratio (β coefficient -31.6 ± 13.8, p=<0.001). An aortic isthmus ratio ≤0.7 was the optimal cut-off to detect left ventricular hypertrophy, showing the strongest correlation with left ventricular mass index (β -31.6, p < 0.001).
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