Circulating biomarkers of left ventricular hypertrophy in pediatric coarctation of the aorta

Abstract

Objective: Patients undergoing surgical repair of aortic coarctation have a 50% risk of pathologic left ventricular remodeling (increased left ventricular mass or relative wall thickness). Endothelin 1, ST2, galectin 3, norepinephrine and B-natriuretic peptide are biomarkers that have been associated with pathologic LV change in adult populations but their predictive value following pediatric coarctation repair are not known. Hypothesis: Biomarker levels at coarctation repair will predict persistent left ventricular remodeling at 1-year follow up. Design: Prospective, cohort study of 27 patients' age 2 days-12 years with coarctation of the aorta undergoing surgical repair. Echocardiograms were performed preoperation, postoperation, and at 1-year follow-up. Plasma biomarker levels were measured at the peri-operative time points. Association between biomarker concentrations and echocardiographic parameters was assessed. Results: Neither left ventricular mass index nor relative wall thickness varied from pre-op to post-op. At pre-op, relative wall thickness was elevated in 52% and left ventricular mass index was elevated in 22%; at follow-up, relative wall thickness was elevated in 13% and left ventricular mass index was elevated in 8%. Presence of residual coarctation did not predict left ventricular remodeling (AUC 0.59; P > .05). Multivariable receiver operating characteristic curve combining pre-op ST2 and endothelin 1 demonstrated significant predictive ability for late pathologic left ventricular remodeling (AUC 0.85; P = .02). Conclusions: Persistent left ventricular hypertrophy and abnormal relative wall thickness at intermediate-term follow-up was rare compared to previous studies. A model combining pre-op endothelin 1 and ST2 level demonstrated reasonable accuracy at predicting persistent abnormalities in this cohort. Larger studies will be needed to validate this finding and further explore the mechanism of persistent left ventricular remodeling in this population. K E Y W O R D S B-type natriuretic peptide (BNP), endothelin-1 (ET-1), galectin-3 (Gal-3), norepinephrine (NE), relative wall thickness (RWT), ST-2 | 447 FRANK et Al.

A Scoping Review of Galectin-3 as a Biomarker of Cardiovascular Diseases in Pediatric Populations

“…The results presented in the study of Frank et al [ 28 ] were not promising, either. They found that galectin-3 did not predict persistent left ventricular hypertrophy nor abnormal wall thickness in children after the cardiosurgical treatment of aortic coarctation.…”

“…On the other hand, the data regarding aortic coarctation and tetralogy of Fallot are less promising. Firstly, according to the trial of Frank et al [ 28 ], galectin-3 is not a useful biomarker for persistent left ventricular remodeling prediction during one-year follow-up in children undergoing surgical repair of aortic coarctation. Secondly, a prospective study in 16 patients with a broad range of age after surgical repair of tetralogy of Fallot [ 29 ] did not reveal any correlation between galectin-3 plasma concentrations and right heart invasive hemodynamic measurements such as right ventricular end-diastolic pressure and mean right atrial pressure in patients undergoing catheterization for pulmonary valve replacement.…”

Application of B-Type Natriuretic Peptide in Neonatal Diseases

“…Das et al ( 35 ) studied 122 CHD neonates with left obstructive lesions and found that the BNP level of the neonates was elevated, especially in neonates with critical congenital heart disease, whose BNP ranged from 553 to > 5,000 pg/ml. A significant increase in plasma BNP levels was also observed in newborns withcoarctation of aorta ( 36 ). Therefore, the BNP level is a good indicator for neonatal heart insufficiency caused by pressure load, especially for left obstructive lesions.…”

4D FLOW Magnetic Resonance Imaging in the Study of Blood Flow in Patients With Aortic Coarctation in the Long-Term After Surgery

“…Публикации последних лет выделяют эндотелин-1, ST2, галектин-3, нор эпинефрин и мозговой натрийуретический пептид в качестве биомаркеров ОРИГИНАЛЬНЫЕ СТАТЬИ § патологических изменений ЛЖ у взрослых с КоАо. Уровни биомаркеров позволяли прогнозировать стойкое ремоделирование ЛЖ через год наблюдения после коррекции коарктации, но окончательная их прогностическая ценность неизвестна [25].…”