Endothelin-1 activation in pediatric patients undergoing surgical coarctation of the aorta repair

Abstract

AIMTo determine endothelin-1 (ET-1) concentration before and after surgical coarctectomy and evaluate its association with left ventricular geometric change.METHODSA prospective, cohort study of 24 patients aged 2 d to 10 years with coarctation of the aorta undergoing surgical repair. A sub-cohort of patients with age < 1 mo was classified as “neonates”. Echocardiograms were performed just prior to surgery and in the immediate post-op period to assess left ventricle mass index and relative wall thickness (RWT). Plasma ET-1 levels were assessed at both time points. Association between ET-1 levels and ventricular remodeling was assessed.RESULTSPatients < 1 year demonstrated higher pre-op ET-1 than post-op (2.8 pg/mL vs 1.9 pg/mL, P = 0.02). Conversely, patients > 1 year had no change in ET-1 concentration before and after surgery (1.1 vs 1.4, NS). Pre-op, patients < 1 year demonstrated significantly higher ET-1 than older children (2.8 vs 1.1, P = 0.001). Post-op there was no difference between the age groups (1.9 vs 1.4, NS). Neither RWT nor left ventricle mass index (LVMI) varied from pre-op to post-op. The subset of neonates showed a strong positive correlation between pre-op ET-1 and RWT (r = 0.92, P = 0.001). Patients with ET-1 > 2 pg/mL pre-op demonstrated higher LVMI (65.7 g/m2.7 vs 38.5 g/m2.7, P = 0.004) and a trend towards higher RWT (45% vs 39%, P = 0.07) prior to repair than those with lower ET-1 concentration.CONCLUSIONET-1 concentration is significantly variable in the peri-operative period surrounding coarctectomy. Older children and infants have different responses to surgical repair suggesting different mechanisms of activation.

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

“…Written assent was obtained from all subjects aged between 7 and 18 years. A manuscript reporting early peri‐operative ET‐1 and echocardiography results from a subset of this cohort has been previously published …”

“…8 No prior study has evaluated the peri-operative concentration of other protein biomarkers or their utility as predictors of persistent LV abnormalities in this population. However, none have been assessed in the peri-operative period surrounding pediatric coarctation of the aorta repair.…”

“…A preliminary report from a subset of this cohort demonstrated early ET-1 activation in neonates undergoing coarctation repair and a modest correlation between ET-1 concentration and early LV thickening. 8 No prior study has evaluated the peri-operative concentration of other protein biomarkers or their utility as predictors of persistent LV abnormalities in this population.…”