Why the study?
Persistent HTN is common after covered stent implantation for CoA, but existing evidence relies mainly on surgical repair cohorts and cross-sectional echocardiography, leaving individual trajectories of LV remodeling after stenting poorly defined.
Does covered stent implantation for coarctation of the aorta resolve hypertension and improve left ventricular remodeling in patients with coarctation of the aorta?
Does covered stent implantation for coarctation of the aorta resolve hypertension and improve left ventricular remodeling in patients with coarctation of the aorta?
Anatomical relief after coarctation of the aorta stenting does not preclude ongoing myocardial burden, as over half of patients experience persistent hypertension and 13.6% of those without baseline LVH develop new-onset LVH, highlighting the need for serial echocardiographic surveillance alongside blood pressure monitoring.
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May prompt closer surveillance after coarctation stenting; leaves open optimal strategies to address remodeling.
Persistent hypertension (HTN) remains common after covered stent implantation for coarctation of the aorta (CoA). However, existing evidence is derived predominantly from surgical repair cohorts and cross-sectional echocardiography, leaving the individual trajectory of left ventricular (LV) remodeling after stenting poorly defined. We retrospectively studied 84 patients with complete persistent HTN status, and 75 patients with paired follow-up echocardiography for LV remodeling analyses. Multivariable logistic and linear regression were performed to identify factors associated with persistent HTN and follow-up LV mass index (LVMI) separately. Paired changes in LV hypertrophy (LVH) and LV geometry were assessed using McNemar and Stuart-Maxwell tests. Persistent HTN occurred in 46 of 84 patients (54.8%) at a median clinical follow-up of 9 years, and was associated with older age at repair and higher preoperative systolic blood pressure. Higher follow-up LVMI was associated with higher baseline LVMI, male sex and longer follow-up duration. At a median echocardiographic follow-up of 2 years, LVH prevalence decreased from 41.3-24.0%. This net decline masked bidirectional individual trajectories: 19 of 31 patients with baseline LVH (61.3%) no longer met LVH criteria, whereas 6 of 44 patients without baseline LVH (13.6%) developed new-onset LVH. Anatomical relief after CoA stenting therefore does not preclude ongoing myocardial burden, and patients developing new-onset LVH would not be identified by preoperative risk stratification alone. Serial echocardiographic assessment should complement long-term blood pressure surveillance, though these findings require validation in larger cohorts with standardized follow-up.
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Zhao et al. (2026) studied this question.
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