Association of preoperative Circulating biomarkers with echocardiographic measures of right ventricular strain five years after tetralogy of fallot repair.

PURPOSE: We analyzed right ventricular (RV) function using echocardiography after tetralogy of Fallot (TOF) repair to investigate the association between preoperative circulating biomarkers and RV strain five years after repair. We hypothesized that biomarkers of myocardial fibrosis and stretch would be correlated with worse mid-term RV function measured by strain.

METHODS

We included children repaired at our institution from 2016 to 2019. Biomarkers measured preoperatively included galectin-3, Procollagen-type-I carboxy-terminal-propeptide (PICP), Procollagen-type-III-amino-terminal-propeptide (PIIINP), matrix-metalloproteinase-1 (MMP1), matrix-metalloproteinase-9 (MMP9), soluble suppression of tumorigenicity-2 (sST2), and N-terminal-pro-B-type-natriuretic-peptide (NT pro-BNP). Function was retrospectively assessed with RV longitudinal peak systolic strain (RVLS), free-wall peak systolic strain (FWS), peak systolic strain-rate (SR) and free-wall systolic strain-rate (FWSR) on available echocardiograms from one to five years after repair. Multivariable linear regression models with Generalized Estimating Equations tested whether preoperative biomarkers were associated with RV strain.

RESULTS

In total, 56 patients were followed with 198 reviewed echocardiograms, with a median of 4 echocardiograms per patient (range 1-5). Strain parameters remained stable until year 2 followed by a significant decrease in all parameters by year 3 through year 5. Higher preoperative levels of MMP1, PICP and PIIINP were associated with worse RVLS. Higher NT-proBNP was associated with better FWSR.

CONCLUSION

RV function is dynamic in the first 5 years after TOF repair but remains stable in the mid-term. Preoperative biomarkers of extracellular matrix turnover could help explain postoperative RV function in patients with TOF.