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Background: Coarctation of the aorta (CoA) is a congenital heart disease which represents a narrowing of the proximal descending aorta, hence increasing pressure afterload to the left ventricle (LV). Conventional treatment of native CoA is surgical repair, however potential recurrence or other related complications e.g. aortic rupture, heart failure and cerebrovascular events are common. Thus, lifelong follow-up of these patients is required. Echocardiography is the most patient’s friendly method to evaluate CoA and in particular its effect on LV function. Moreover, the novel speckle tracking echocardiography (STE) is an important method to assess subclinical LV dysfunction, a technique that promises better evaluation of LV function in these patients. The aims of this thesis were to review the literature on LV function in children with CoA using myocardial deformation imaging technologies, hence, to better understand the current knowledge and vagueness of the scientific evidence. We also aimed to study the effect of early CoA repair on the structure and function of LV and ascending aorta. In addition, we wished to establish in a meta-analysis format normal values of speckle tracking derived strain and strain rate values. Methods: Study 1. We have systematically searched the PubMed, and studies that fulfilled the inclusion criteria were critically analyzed and presented on a narrative form. Study 2 and 3. In addition to conventional echocardiographic measures of LV and ascending aorta, we measured longitudinal strain and strain rate of the LV using a vendor independent software, TomTec. We have also measured the aorto-septal angle (AoSA). Data was compared with normal healthy controls. Study 4. Electronic databases were systematically searched and suitable studies were meta analyzed using Comprehensive meta-analysis version 3 software. Results: Study 1. In 7/4945 included articles, 123 and 76 patients with congenital aortic stenosis (CAS) and CoA were reported, respectively. Normal conventional LV function, with subclinical myocardial dysfunction were reported in all studies before intervention. After intervention, a consistent improvement of myocardial deformation parameters was documented, even though not reaching normal values. Study 2. In 21 patients with CoA, LV function significantly improved after intervention (p <0.001), however normal values were not reached even at medium-term follow-up (p = 0.002). Medium-term longitudinal strain correlated with pre intervention LV ejection faction (EF) (r = 0.58, p = 0.006). Medium-term subnormal values were more frequently associated with Bicuspid aortic valve (BAV) (33.3% vs. 66.6%; p <0.05). Study 3. AoSA was abnormally wide before intervention, in particular at peak ejection in the descending aorta (p <0.0001), and correlated with CoA pressure gradient. After intervention, AoSA normalized and significantly correlated with the increase of LV cavity function and overall LV deformation parameters. Study 4. In a meta-analysis of 28/282 studies including 1192 subjects, strain and strain rate values were established. Longitudinal strain normal mean values varied from -12.9 to -26.5 (mean, -20.5; 95 % CI, -20.0 to -21.0). Normal mean values of circumferential strain varied from -10.5 to -27.0 (mean, -22.06; 95 % CI, -21.5 to -22.5). Radial strain normal mean values varied from 24.9 to 62.1 (mean, 45.4; 95 % CI, 43.0 to 47.8). Meta-regression showed LV end-diastolic diameter as a significant determinant of variation of longitudinal strain. Longitudinal systolic strain rate was significantly determined by age and radial strain was influenced by the type of vendor used. Conclusion: The systematic review showed subclinical LV dysfunction in children with CoA before and after correction. However, since most of the patients were operated at an older age and had preserved LV EF, the effect of early intervention on LV function was only speculated. Our children with CoA who were operated at an earlier age showed LV subclinical dysfunction even at medium- term after intervention while the AoSA returned to normal shortly after intervention. Lower longitudinal strain values were found in patients with LV dysfunction (LV EF <50%) before intervention and BAV. Finally, normal range values for strain and strain rate have been established and seem to be influenced by patients’ age, LV end-diastolic diameter and vendor used.

Le vieillissement cardiaque est fortement associé à l’apparition d’une fibrose pouvant entrainer une dysfonction progressive du remplissage et de l’éjection ventriculaire. Le dépistage du remodelage et du vieillissement cardiovasculaire sont primordiaux afin de proposer des stratégies de prévention et de prises en charge spécifiques visant à retarder l’apparition ou ralentir la progression d’une insuffisance cardiaque à fraction d’éjection préservée. Les outils cliniques, biologiques ou d’imagerie sont insuffisamment performants à l’heure actuelle pour dépister ces modifications précoces ou prédire l’apparition de remodelage ultérieur de façon efficace. La réalisation d’une méta-analyse avec revue de la littérature, nous a permis de montrer la valeur de la déformation myocardique comme marqueur du remodelage cardiovasculaire dans le post-infarctus, mais nous a aussi éclairé sur la complexité du phénomène et le manque de preuves sur sa potentielle valeur additionnelle en pratique clinique. Après avoir validé les différents outils de quantification du remodelage dans nos cohortes, nous avons montré l’importance d’une expertise précise de la morphologie et de la fonction cardiaque lors d’un évènement aigu pour prédire un remodelage ultérieur. Nous avons précisé le rôle de la déformation myocardique dans la quantification de la taille de l’infarctus, sa sévérité et son éventuelle extension au ventricule droit. Enfin, nous avons mis en relation les paramètres de contractilité et de fonction vasculaire en montrant la valeur du couplage ventriculo artériel mesuré en IRM. Ces travaux ouvrent la voie pour une stratégie d’évaluation d’imagerie précoce en post-infarctus pouvant orienter les thérapeutiques de revascularisation et/ou de réhabilitation / Cardiovascular aging is strongly associated with myocardial fibrosis and progressive LV systolic/diastolic dysfunction including vascular stiffening. Cardiac remodeling with left ventricular parietal stress and hypertrophy take place over several years and can ultimately lead to the occurrence of heart failure. Clinical, biological or imaging tools are currently insufficient to detect early changes or to predict the onset of subsequent remodeling in an effective manner. However, if subclinical structural and functional cardiac abnormalities are not detected by conventional echocardiographic techniques, they may be evaluated by others imaging tools with the measurement of myocardial deformation parameters. We performed a systematic review suggesting that deformation imaging is associated with left ventricular volume and function changes regardless the mechanisms and deformation direction. But added strain predictive value over other clinical, biological and imaging variables remains to prove. After validation of various remodeling indices, we proved the add value of a comprehensive assessment of ventricule geometry and function to evaluate remodeling after an acute event. We confirmed the central role of myocardial deformation for infarct size quantification and detect right ventricle extension. Finally, we used vascular function measured by MRI to demonstrate the relation between ventriculo-arterial coupling and remodeling. Further studies are needed to assess the gain in information provided by strain and these new biomarkers.