@Article{chd.12744,
AUTHOR = {Benjamin S. Frank, Tracy T. Urban, Karlise Lewis, Suhong Tong, Courtney Cassidy, Max B. Mitchell, Christopher S. Nichols, Jesse A. Davidson},
TITLE = {Circulating biomarkers of left ventricular hypertrophy in pediatric coarctation of the aorta},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {3},
PAGES = {446--453},
URL = {http://www.techscience.com/schd/v14n3/38789},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> Patients undergoing surgical repair of aortic coarctation have a 50% risk 
of pathologic left ventricular remodeling (increased left ventricular mass or relative 
wall thickness). Endothelin 1, ST2, galectin 3, norepinephrine and B‐natriuretic pep‐
tide are biomarkers that have been associated with pathologic LV change in adult 
populations but their predictive value following pediatric coarctation repair are not 
known.<br/>
<b>Hypothesis:</b> Biomarker levels at coarctation repair will predict persistent left ven‐
tricular remodeling at 1‐year follow up.<br/>
<b>Design:</b> Prospective, cohort study of 27 patients’ age 2 days‐12 years with coarcta‐
tion of the aorta undergoing surgical repair. Echocardiograms were performed pre‐
operation, postoperation, and at 1‐year follow‐up. Plasma biomarker levels were 
measured at the peri‐operative time points. Association between biomarker concen‐
trations and echocardiographic parameters was assessed.<br/>
<b>Results:</b> Neither left ventricular mass index nor relative wall thickness varied from 
pre‐op to post‐op. At pre‐op, relative wall thickness was elevated in 52% and left 
ventricular mass index was elevated in 22%; at follow‐up, relative wall thickness was 
elevated in 13% and left ventricular mass index was elevated in 8%. Presence of re‐
sidual coarctation did not predict left ventricular remodeling (AUC 0.59; P > .05). 
Multivariable receiver operating characteristic curve combining pre‐op ST2 and en‐
dothelin 1 demonstrated significant predictive ability for late pathologic left ven‐
tricular remodeling (AUC 0.85; P = .02).<br/>
<b>Conclusions:</b> Persistent left ventricular hypertrophy and abnormal relative wall thick‐
ness at intermediate‐term follow‐up was rare compared to previous studies. A model 
combining pre‐op endothelin 1 and ST2 level demonstrated reasonable accuracy at 
predicting persistent abnormalities in this cohort. Larger studies will be needed to 
validate this finding and further explore the mechanism of persistent left ventricular 
remodeling in this population.},
DOI = {10.1111/chd.12744}
}