Heart failure biomarker levels correlate with invasive haemodynamics in pulmonary valve replacement

AbstractBackground:Although widely used in cardiology, relation of heart failure biomarkers to cardiac haemodynamics in patients with CHD (and in particular with pulmonary insufficiency undergoing pulmonary valve replacement) remains unclear. We hypothesised that the cardiac function biomarkers N-terminal pro-brain natriuretic peptide (NT-proBNP), soluble suppressor of tumorigenicity 2, and galectin-3 would have significant associations to right ventricular haemodynamic derangements.Methods:Consecutive patients ( n = 16) undergoing cardiac catheterisation for transcatheter pulmonary valve replacement were studied. NT-proBNP, soluble suppressor of tumorigenicity 2, and galectin-3 levels were measured using a multiplex enzyme-linked immunosorbent assay from a pre-intervention blood sample obtained after sheath placement. Spearman correlation was used to identify significant correlations (p ≤ 0.05) of biomarkers with baseline cardiac haemodynamics. Cardiac MRI data (indexed right ventricular and left ventricular end-diastolic volumes and ejection fraction) prior to device placement were also compared to biomarker levels.Results:NT-proBNP and soluble suppressor of tumorigenicity 2 were significantly correlated (p < 0.01) with baseline mean right atrial pressure and right ventricular end-diastolic pressure. Only NT-proBNP was significantly correlated with age. Galectin-3 did not have significant associations in this cohort. Cardiac MRI measures of right ventricular function and volume were not correlated to biomarker levels or right heart haemodynamics.Conclusions:NT-proBNP and soluble suppressor of tumorigenicity 2, biomarkers of myocardial strain, significantly correlated to invasive pressure haemodynamics in transcatheter pulmonary valve replacement patients. Serial determination of soluble suppressor of tumorigenicity 2, as it was not associated with age, may be superior to serial measurement of NT-proBNP as an indicator for timing of pulmonary valve replacement.

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REDUCTION OF ADVERSE VENTRICULAR INTERACTION AFTER TRANSCATHETER PULMONARY VALVE REPLACEMENT IN PATIENTS WITH RIGHT VENTRICULAR OUTFLOW TRACT OBSTRUCTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(14)60519-2 ◽

2014 ◽

Vol 63 (12) ◽

pp. A519

Author(s):

Fatima Lunze ◽

Babar Hasan ◽

Kimberlee Gauvreau ◽

David Brown ◽

Steven Colan ◽

...

Keyword(s):

Right Ventricular ◽

Valve Replacement ◽

Pulmonary Valve ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Pulmonary Valve Replacement ◽

Outflow Tract ◽

Ventricular Outflow Tract Obstruction ◽

Ventricular Interaction ◽

Transcatheter Pulmonary Valve Replacement

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PATIENT-SPECIFIC SIMULATION OF RIGHT VENTRICLE OUTFLOW TRACT CONDUIT BALLOON ANGIOPLASTY USING CARDIAC MRI-DERIVED 3D VIRTUAL MODELS TO ASSESS THE RISK OF CORONARY ARTERY COMPRESSION DURING TRANSCATHETER PULMONARY VALVE REPLACEMENT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)60572-1 ◽

2015 ◽

Vol 65 (10) ◽

pp. A572

Author(s):

Puneet Bhatla ◽

Sujata Chakravarti ◽

Achiau Ludomirsky ◽

Michael Argilla ◽

Phillip Berman ◽

...

Keyword(s):

Coronary Artery ◽

Right Ventricle ◽

Valve Replacement ◽

Balloon Angioplasty ◽

Cardiac Mri ◽

Pulmonary Valve ◽

Pulmonary Valve Replacement ◽

Outflow Tract ◽

Patient Specific ◽

Transcatheter Pulmonary Valve Replacement

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Abstract 13811: The Clinical Significance of End-diastolic Forward Flow on the Prognosis After Pulmonary Valve Replacement in Patients Late After Repair of Tetralogy of Fallot

Circulation ◽

10.1161/circ.142.suppl_3.13811 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Yuji Tominaga ◽

Masaki Taira ◽

Tomomitsu Kanaya ◽

Kanta Araki ◽

Takuji Watanabe ◽

...

Keyword(s):

Risk Factor ◽

Right Ventricular ◽

Diastolic Dysfunction ◽

Tetralogy Of Fallot ◽

Valve Replacement ◽

Pulmonary Valve ◽

Pulmonary Valve Replacement ◽

Right Atrial ◽

Atrial Tachyarrhythmia ◽

Forward Flow

Introduction: Restrictive right ventricular physiology (r-RVP) is common in late after repair of tetralogy of Fallot (TOF) and reported to reflect diastolic dysfunction. Right ventricular (RV) diastolic dysfunction sometimes remains after pulmonary valve replacement (PVR) and is associated with arrhythmia. Pulmonary arterial end-diastolic forward flow (EDFF) is considered as a marker of r-RVP, and associated with RV volume, right atrial (RA) function, and the degree of pulmonary valve regurgitation (PR). The aim of this study is to evaluate the impact of EDFF before PVR on the clinical outcomes after PVR in patients with repaired TOF. Methods: This was a single-center, retrospective review of 46 patients who underwent PVR for moderate to severe PR between 2003 and 2019. Cases were examined EDFF before PVR and divided into two groups: with EDFF (EDFF+, n=23) and without EDFF (EDFF-, n=23). Patients with histories of atrial tachyarrhythmia underwent concomitant maze procedure. RV and RA volume were evaluated by magnetic resonance imaging. Post-PVR survival and the development of arrhythmia were assessed. Results: Age at PVR was 38±14 in EDFF+ and 35±10 years old in EDFF- (p=0.41), and the incidence of preoperative arrhythmia was not different (30% and 35%, p=1.0). RVESVI (102±24 and 86±26 ml/m 2 , p=0.048) and RAVI (84±19 and 70±20 ml/m 2 , p=0.025) before PVR, and RVEDVI (116±27 and 100±24 ml/m 2 , p=0.04) and RVESVI (71±23 and 55±16 ml/m 2 , p=0.01) at one year after PVR were greater in EDFF+. One patient in each group died due to non-cardiac disease. 5-year atrial tachyarrhythmia free rate was 62% in EDFF+ and 100% in EDFF- (Log-rank p=0.004). Multivariate Cox regression analysis revealed EDFF before PVR was a risk factor for atrial tachyarrhythmia after PVR (Hazard ratio 17 (95% CI, 2.2-406), p=0.025). Conclusions: EDFF before PVR was a significant risk factor for the development of postoperative atrial tachyarrhythmia. EDFF can complement the current indication for PVR.

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