The challenge of assessing left ventricular function after repair of aortic coarctation: Can we do better?

When studied in long-term follow up, a large fraction of patients who have undergone repair of coarctation of aorta (COA) have arterial hypertension, 1,2 which has been attributed to increased aortic stiffness.3 A similar mechanism may explain the enhanced exercise-induced increase in systolic arterial pressure in this group of patients.4 As shown by Egbe et al. 5 COA-treated patients have higher LV diastolic stiffness, impaired LV relaxation and slightly elevated LV end-diastolic pressure.Studies of LV systolic function in patients with successful COA repair have demonstrated reduced LV global longitudinal strain (GLS), whereas LV ejection fraction (EF) was normal in the majority of patients.6,7 As shown by Kutty et al. 6 in a study which used cardiac magnetic resonance imaging, the reduction of GLS was most marked in the subgroup of patients with LV hypertrophy, suggesting that impairment of LV systolic function may be coupled to remodeling.The traditional method for measuring LV contractile function is by EF, which has proven very useful in patient management.An important limitation of this parameter, however, is in heart failure (HF) diagnostics, as it fails to identify systolic function in nearly one half of all HF patients, a condition named HF with preserved EF (HFpEF). One reason why EF does not identify systolic dysfunction in