Patients with repaired aortic coarctation (CoA) are prone to develop early left ventricular (LV) and left atrial (LA) dysfunction due to chronic abnormal LV afterload. Clinical and prognostic relevance of LA function, including LA strain analysis, is increasingly recognized particularly for predicting incident atrial fibrillation and stroke. This study examined the prevalence of left atrial dysfunction (LAD) in patients with corrected CoA and the relationship between LA function and patient characteristics.

56 patients (34 males, age: 31±16 years) who underwent CoA repair (46 post ‘end-to-end anastomosis/sub-clavian flap’, 10 post ‘stenting/bypass/Teflon patch’) and 56 controls were studied. 2D strain imaging was performed to assess left ventricular (LV) and LA functions including peak positive LA strain (LAS), early diastolic and late diastolic LA strains, global longitudinal LV strain (LV-GLS), and circumferential strain (LV-GCS). LAD was defined as LAS value lower than the mean value of the control group minus 2 SDs.

LAS, early and late diastolic LA strains, and LV-GLS were significantly lower in the CoA group while LV-GCS did not differ. No significant correlation was found between LAS and either current age, age at initial repair or blood pressure values. Among echocardiographic parameters, Ea and LV-GLS were moderately correlated to LAS (r=0.49, p<0.001 and r=−0.55, P<0.001 respectively); 23 CoA patients (41%) developed LAD (LAS<25%). Among the patients who underwent end-to-end anastomosis/subclavian flap, those with a non-romanesque aortic arch anatomy exhibited a significantly lower LAS. Ischemic stroke and atrial arrhythmia were more frequent in CoA patients with LAD.

Based on LAS analysis, LAD is prevalent after CoA repair. Post-operative aortic arch anatomy may impact peak positive LA strain. LA strain may help screening high-risk patients for atrial arrhythmia and stroke after CoA repair.