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Published on: February 3, 2014
Noninvasive perioperative evaluation of right ventricular function in children with tetralogy of Fallot
Jing-Jing Ye1, Qiang Shu, Xi-Wang Liu
1Department of Ultrasonography, The Children's Hospital of Zhejiang University and Zhejiang Key Laboratory for Diagnosis and Therapy of Neonatal Diseases, Hangzhou, China.
Insights
Noninvasive imaging and biomarkers like NT-proBNP can identify right ventricular (RV) dysfunction in children with tetralogy of Fallot (TOF). RV function and NT-proBNP levels did not improve after TOF repair, suggesting persistent dysfunction.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Biomarkers in Congenital Heart Disease
Background:
- Right ventricular (RV) dysfunction is a concern in children with tetralogy of Fallot (TOF).
- Early, noninvasive methods are needed to assess RV function in pediatric TOF patients.
- Tissue Doppler imaging (TDI), strain rate (SR), and strain analysis (SA) are advanced echocardiographic techniques.
Purpose of the Study:
- To evaluate RV systolic and diastolic function using TDI, SR, and SA in children with TOF before and after surgical repair.
- To assess plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and matrix metalloproteinase 9 (MMP-9) in relation to RV function.
- To determine if RV function improves post-TOF repair and its correlation with biomarkers.
Main Methods:
- Echocardiographic assessment of RV function (TDI, SR, SA) in 37 children pre-TOF repair, 32 post-repair, and 37 controls.
- Measurement of plasma NT-proBNP and MMP-9 concentrations.
- Correlation analysis between RV function indices and biomarker levels.
Main Results:
- Preoperative RV systolic and diastolic function indices were lower in TOF patients compared to controls and did not improve post-repair.
- Plasma NT-proBNP levels were elevated in TOF patients pre- and post-repair compared to controls.
- NT-proBNP correlated with RV systolic SR and strain; MMP-9 correlated with NT-proBNP.
Conclusions:
- RV dysfunction persists after TOF repair, as indicated by echocardiographic measures and elevated NT-proBNP.
- Plasma NT-proBNP is a potential noninvasive biomarker for identifying RV dysfunction in pediatric TOF.
- Monitoring NT-proBNP may help detect symptomatic RV dysfunction early in TOF patients.
Abstract:
Early and accurate noninvasive means of identifying right ventricular (RV) dysfunction in children with tetralogy of Fallot (TOF) are needed. RV function was examined using tissue Doppler imaging (TDI), strain rate (SR), and strain analysis (SA) in children before (N = 37) and after (6-12 months; N = 32) TOF repair, and in a control group of children (N = 37). Plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and matrix metalloproteinase 9 (MMP-9) were measured. TDI, SR, and SA revealed that RV systolic and diastolic function indices were lower preoperatively in the TOF group compared with the control group, and did not improve after TOF repair. Plasma NT-proBNP concentrations were significantly higher in the TOF group pre- and postoperatively compared with the control group. In the preoperative TOF group, NT-proBNP concentration was significantly correlated with peak systolic SR and systolic strain in the mid segments of RV free wall. Plasma MMP-9 concentrations were significantly increased in the preoperative TOF group compared with the control group, and significantly correlated with plasma NT-proBNP and logNT-proBNP concentrations. RV function correlated with plasma NT-proBNP concentrations in children with TOF. Assessment of this noninvasive measure may help identify RV dysfunction in patients with TOF before they become clinically symptomatic.
