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Serum Angiopoetin-2 Levels in Pediatric Patients After Fontan Operation
Keijiro Ibuki1, Teruhiko Imamura2, Hideyuki Nakaoka1
1Department of Pediatrics.
Insights
Serum angiopoietin-2 levels are elevated in pediatric patients post-Fontan operation. Higher levels indicate an increased risk of adverse events and mortality in these patients.
Area of Science:
- Pediatric Cardiology
- Biomarkers
- Congenital Heart Disease
Background:
- Angiopoietin-2 (Ang-2) is linked to chronic inflammation and angiogenesis.
- Its role in pediatric patients undergoing the Fontan operation is not well understood.
Purpose of the Study:
- To compare serum Ang-2 levels in pediatric Fontan patients versus a control group with congenital heart disease.
- To investigate Ang-2 as a risk factor for adverse outcomes after the Fontan operation.
Main Methods:
- A cohort of 185 pediatric patients (140 Fontan, 45 controls) was analyzed.
- Serum Ang-2 levels were measured and compared between groups.
- Statistical analysis identified risk factors for adverse events.
Main Results:
- Fontan patients exhibited significantly higher serum Ang-2 levels (7,670 pg/ml) compared to controls (2,351 pg/ml).
- Elevated Ang-2 (log10 ≥3.9) was an independent risk factor for death or adverse events (aHR 6.25, p=0.007).
- Preoperative desaturation was associated with higher postoperative Ang-2 levels (p=0.047).
Conclusions:
- Serum Ang-2 levels are elevated in pediatric patients following the Fontan operation.
- Higher Ang-2 levels serve as an independent predictor of poor outcomes in Fontan patients.
- Further research is needed to determine the clinical utility of monitoring Ang-2 in this population.
Abstract:
Angiopoietin-2 is associated with chronic inflammation and angiogenesis, but its activity after Fontan operation in pediatric patients remains uncertain. We compared serum angiopoietin-2 levels in pediatric patients after Fontan operation versus those with congenital heart disease as a control group. A total of 185 patients (median age 7 [3 to 12] years, 106 males) were included, consisting of 140 in the Fontan group and 45 in the control group. Serum angiopoietin-2 levels were significantly higher in the Fontan group (7,670 vs 2,351 pg/ml, p <0.001). In the Fontan group, a serum angiopoietin-2 level ≥3.9 of common logarithm was an independent risk factor for death or Fontan-related adverse events with an adjusted hazard ratio of 6.25 (95% confidence interval 1.64 to 23.9, p = 0.007). In preoperative variables, desaturation was independently associated with increased serum angiopoietin-2 levels after Fontan operation (p = 0.047). In conclusion, serum angiopoietin-2 levels were elevated in the pediatric phase after Fontan operation. In Fontan patients, a higher serum angiopoietin-2 level was an independent risk factor for death or Fontan-related adverse events. The clinical implication of measuring and monitoring serum angiopoietin-2 levels in this cohort requires further investigation.
