Introduction: Stented coarctation is associated with increased ventricular and aortic stiffness. This study compared non-invasively determined ventricular-vascular interactions in patients after stented coarctation with healthy age/sex-matched controls.

Methods: Ventricular assessment included M-mode, B-mode, pulse and tissue Doppler echocardiography. Vascular assessment included carotid ultrasound, applanation tonometry and echo-Doppler assessment of the biophysical properties of the aorta. Ventricular-arterial coupling assessed as the ratio between arterial elastance (Ea) and end-systolic ventricular elastance (Ees), was calculated using SBP, DBP, echo-derived stroke volume and the ratio between aortic pre-ejection time and total systolic time. Between groups comparisons were performed using parametric methods with p-values>0.05 considered significant.

Results: Thirty patients after stented coarctation (4 females; median age 17.2 [range 8.1–28.2] years; 11 after initial surgical repair) were studied. Stented patients were slightly older, but of similar height and BMI to controls. Peripheral and centrally derived SBP and radial augmentation index were lower and CIMT higher in stented patients. Carotid, ascending and abdominal aorta distensibility, pulse wave velocities and biophysical properties of the aorta were all similar, except for input impedance which was lower in stented patients. LV mass was higher and diastolic parameters suggested abnormal relaxation in stented patients. Ea and Ees were both reduced in stented patients, but ventricular-arterial coupling ratio Ea/Ees was similar.

Conclusion: After stented coarctation, elevated central systolic and augmentation pressures can be shown in association with abnormal ventricular relaxation. Although arterial and end-systolic ventricular elastance are reduced the ratio is similar to controls, suggesting an adaptive response of the ventricular-arterial coupling.