Circulating Biomarkers are Associated with Impaired Right Ventricular Circumferential and Longitudinal Strain Measured by Cardiac Magnetic Resonance Imaging in Children and Adolescents with Repaired Tetralogy of Fallot

Prior studies have shown that circulating biomarkers are associated with increased myocardial fibrosis and worse outcomes in patients with surgically repaired tetralogy of Fallot (rTOF). However, associations of circulating biomarkers with right and left ventricular myocardial deformation using strain by cardiac magnetic resonance (CMR) imaging remain understudied. We aimed to investigate whether these associations in rTOF youth undergoing CMRs inform ventricular remodeling. Eight circulating biomarkers were measured in rTOF patients at the time of CMR. Right and left ventricular (RV, LV) longitudinal (GLS) and circumferential (GCS) strain were measured offline using cvi42 Tissue Tracking®. Associations between strain and CMR RV/LV parameters and biomarkers were assessed using correlation coefficients and linear regression models adjusted for age at CMR and sex. Fifty-one patients were analyzed (51% female). Worse RVGLS was associated with worse RVEF (ejection fraction), LVEF and LVGS. RVGCS was associated with RVEF. Higher MMP1 was associated with worse RV remodeling, including increased RV end-diastolic volume, lower RVEF and worse RVGCS. Higher sST2 was associated with worse LVEF. Higher NTproBNP was associated with worse RVGCS, more notable in females. We identified three biomarkers (MMP1, sST2 and NTproBNP) associated with ventricular remodeling. Examining changes in these biomarkers over time and their association with ventricular remodeling will help determine if circulating biomarkers can identify early ventricular dysfunction in rTOF. RVGCS may be an important measure to study further in the assessment of RV function after TOF repair.