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Albumin-Bilirubin Score and Subclinical Right Ventricular Dysfunction After Repair of Tetralogy of Fallot
Erhan Sönmez1, Özge Pamukçu Akay2, Yunus Emre Kum3
1Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Insights
The albumin-bilirubin (ALBI) score did not detect early right ventricular dysfunction in pediatric patients after tetralogy of Fallot (TOF) repair. Further studies are needed to assess ALBI score in more advanced stages of heart failure.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Biomarker Discovery
Background:
- Right ventricular (RV) dysfunction is critical in long-term outcomes after tetralogy of Fallot (TOF) surgical repair.
- Early detection of subclinical RV dysfunction and right-sided heart failure in pediatric TOF patients is clinically important.
- The albumin-bilirubin (ALBI) score, a liver function marker, is a potential indicator of systemic congestion in heart failure.
Purpose of the Study:
- To assess if the ALBI score reflects RV dysfunction in pediatric patients post-TOF repair.
- To investigate the relationship between the ALBI score, N-terminal pro-brain natriuretic peptide (NT-proBNP), and echocardiographic indices in these patients.
Main Methods:
- A cross-sectional study included 46 pediatric patients (<8 years) with repaired TOF and 46 age-matched healthy controls.
- Data collected included clinical information, ALBI score, NT-proBNP levels, and comprehensive echocardiographic measurements.
- Statistical analyses examined associations between the ALBI score and various clinical, biochemical, and imaging variables.
Main Results:
- Repaired TOF patients showed elevated NT-proBNP and echocardiographic signs of subclinical RV dysfunction compared to controls.
- The ALBI score was not significantly different between TOF patients and controls.
- No significant association was found between the ALBI score and functional class, anti-congestive therapy, NT-proBNP, or echocardiographic parameters.
Conclusions:
- The ALBI score did not identify early RV dysfunction in this cohort of pediatric patients with repaired TOF.
- Further prospective studies involving patients with more significant hemodynamic impairment are necessary.
- The prognostic or monitoring value of the ALBI score in later stages of RV dysfunction requires further investigation.
Background:
Right ventricular (RV) dysfunction is a key determinant of long-term morbidity in patients following surgical repair of tetralogy of Fallot (TOF). Identifying practical biomarkers for early detection of right-sided heart failure remains clinically relevant, particularly in pediatric populations with subclinical disease. The albumin-bilirubin (ALBI) score, a simple and objective marker of hepatic function, has emerged as a potential surrogate of systemic congestion in heart failure. This study aimed to evaluate whether the ALBI score reflects right ventricular dysfunction in pediatric patients after TOF repair and to examine its relationship with N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiographic indices.
Methods:
In this cross-sectional study, 46 pediatric patients (<8 years) with repaired TOF and 46 age-matched healthy controls were enrolled. Clinical data, laboratory parameters including ALBI score and NT-proBNP, and comprehensive echocardiographic measurements were obtained. Associations between ALBI score and demographic, biochemical, and imaging variables were analyzed.
Results:
The median postoperative time since surgical repair was 99 months. Compared with controls, repaired TOF patients exhibited significantly elevated NT-proBNP levels (p < 0.001), increased RV and right atrial diameters (p < 0.001 and p = 0.017), and reduced tricuspid annular plane systolic excursion (p < 0.001), indicating subclinical RV dysfunction. However, the ALBI score did not differ between groups (p = 0.848) and showed no significant association with functional class, anti-congestive therapy, NT-proBNP levels, or echocardiographic parameters.
Conclusion:
Despite structural and biomarker evidence of subclinical RV involvement, the ALBI score did not reflect early right ventricular dysfunction in this relatively stable pediatric TOF cohort. Prospective studies including patients with more advanced hemodynamic impairment are warranted to clarify whether ALBI may have prognostic or monitoring value in later stages of right ventricular dysfunction.
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