Key result
Asymptomatic patients with ALCAPA late after successful repair had significantly lower global LV longitudinal strain compared to healthy controls (-17.6% vs. -23.4%, p < 0.0001).
Why the study?
The status of left ventricular mechanics including diastolic function and deformation in asymptomatic ALCAPA patients late after successful repair with preserved LVEF was not well characterized.
Are left ventricular mechanics impaired in asymptomatic ALCAPA patients late after successful repair despite preserved LVEF compared to healthy controls?
Case-Control (n=46)
Are left ventricular mechanics impaired in asymptomatic ALCAPA patients late after successful repair despite preserved LVEF compared to healthy controls?
Answers are grounded in this paper and cite their sources.
Despite preserved LVEF, asymptomatic ALCAPA patients late after repair exhibit impaired diastolic function, LV longitudinal deformation, and LV torsion, suggesting a need for detailed echocardiographic follow-up.
OBJECTIVE: Our aim was to evaluate left ventricular (LV) mechanics by using speckle tracking echocardiography (STE) in asymptomatic patients with abnormal origin of the left main coronary artery from the pulmonary trunk (ALCAPA), late after successful repair, in the presence of LV ejection fraction (EF) >50%. METHODS: We studied 30 ALCAPA patients (median age 4 years, range 1-25 years, NYHA class I, LVEF >50%) and 16 healthy age- and sex-matched controls (median age 5 years, range 1-25 years). All underwent standard echocardiographic evaluation and STE. RESULTS: LV dimensions and LVEF (63.6 ± 8.2% vs. 64.1 ± 5.1%, p = 0.826) were not different between patients and controls. Diastolic parameters were significantly abnormal in our patients versus controls (E/e' average: 11.9 ± 5.8 vs. 6.6 ± 3.0, p = 0.0014). Global LV longitudinal strain was significantly lower in ALCAPA patients versus controls (-17.6 ± 3.5% vs. -23.4 ± 3.1%, p < 0.0001). LV torsion (9.1 ± 4.9° vs. 11.9 ± 3.3°, p = 0.046) was significantly impaired in ALCAPA patients. CONCLUSIONS: After successful repair in asymptomatic ALCAPA patients, despite an LVEF >50%, diastolic function, LV longitudinal deformation and LV torsion remain impaired. We suggest including a detailed study of the diastolic function and cardiac mechanics in the clinical follow-up of these patients to identify the subgroup of patients at higher risk.
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Salvo et al. (2016) conducted a case-control in Abnormal origin of the left main coronary artery from the pulmonary trunk (ALCAPA) (n=46). ALCAPA late after successful repair vs. Healthy age- and sex-matched controls was evaluated on Global LV longitudinal strain (p=<0.0001). Asymptomatic patients with ALCAPA late after successful repair had significantly lower global LV longitudinal strain compared to healthy controls (-17.6% vs. -23.4%, p < 0.0001).
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