Reverse Cardiac Remodeling Induced by Endovascular Treatment of Coarctation of the Aorta.

Limited research has explored the transformation of echocardiographic parameters during mid- to long-term follow-up in patients with native coarctation of the aorta (CoA) managed through stenting. This study assesses changes in echocardiographic parameters among patients undergoing stent coarctoplasty, by comparing baseline and 3-year transthoracic echocardiographic (TTE) parameters. In our earlier work, we detailed the 3-year clinical safety and efficacy outcomes of balloon-expandable versus self-expandable stents for treating native CoA within a randomized clinical trial. The current substudy aims to assess the mid-term effects of stenting by examining all participants with available baseline and 3-year core laboratory-confirmed TTE data. Of the 92 patients enrolled in the randomized trial, 32 individuals (median age: 32 years [IQR: 24.8-37.5]) were included in this substudy. At the 3-year follow-up, significant improvements were observed in myocardial diastolic function, characterized by increased septal E' and lateral E' velocities (p = 0.02 and p = 0.03, respectively) and decreased septal and lateral E/E' ratios (10.84 ± 2.83 to 9.21 ± 3.17, p = 0.02 and 7.39 ± 2.24 to 6.29 ± 1.97, p = 0.02, respectively). At the 3-year follow-up, a significant reduction in left ventricular (LV) mass was observed, decreasing from 160 g (IQR: 130-203) to 142 g (IQR: 121-172) (p = 0.001). Among the 12 patients (37.5%) presenting with baseline LV hypertrophy, nine individuals (75%) experienced normalization, demonstrating a substantial improvement in LV mass. Additionally, the prevalence of diastolic dysfunction significantly decreased from 12 patients (41.3%) to four patients (13.7%) at the 3-year evaluation. In adult patients with de novo native CoA, stent coarctoplasty was found to result in significant and sustained improvements in LV diastolic function and reduced LV mass during the mid-term follow-up. Our findings imply that baseline structural parameters may serve as stronger predictors of long-term therapeutic outcomes than demographic factors. Iranian Registry of Clinical Trials: IRCT20181022041406N3.