Anne-Marie Koop

8 293 Table 3. Correlation between serum biomarker levels and tricuspid annular plane systolic excursion assessed in all patients Biomarker TAPSE (r) P-value hs TnT, ng/l -0.159 0.087 NT-proBNP, ng/l -0.365 <0.001* Galectin-3, ng/ml -0.079 0.395 MR-proADM, nmol/l -0.009 0.920 GDF-15, pg/ml 0.003 0.976 MPO, ng/ml -0.145 0.118 ET-1, pg/ml 0.010 0.911 Neprilysin, ng/ml 0.055 0.560 TAPSE: tricuspid annular plane systolic excursion; hs TnT: high-sensitive Troponin T; NT-proBNP: N-terminal pro-B-Type natriuretic peptide; MR-proADM: midregionalproadrenomedullin; GDF-15: growth differentiation factor 15; MPO: myeloperoxidase; ET-1: Endothelin-1; * remained significant after adjusting for age and sex. DISCUSSION The aim of this study was to investigate multi-biomarker serum profiles in children with different RV overload conditions in order to identify degree of RV load, RV remodelling and RV function, also in early stages of disease. In children with CHD, multi-biomarker profiles - defined by changes in the plasma levels of a panel of eight selected circulating biomarkers - were associated with both the type and the degree of RV overload. Although the direction of changes in plasma levels of this panel of selected biomarkers seemed comparable in the different types of RV overload, RV pressure overload was associated with the most prominent changes in biomarker plasma levels, that correlated with echocardiographic RV function and remodelling. NT-proBNP and ET-1 plasma levels were able to identify the presence and degree of RV pressure overload, but not volume overload. An increase in hsTnT serum level showed to indicate severe RV pressure overload. In RV volume overload, no association between this biomarker profile and the severity of overload could be demonstrated. Increased plasma levels of a spectrum of biomarkers, hsTnT, NT-proBNP, MR-proADM, GDF-15, MPO and ET-1 were associated with RVH, were the associated trends of the various biomarker plasma levels with severity of pressure overload and RVH may reflect timing of the molecular processes activated during RV adaptation. Since each biomarker represents specific pathways involved in ventricular remodelling, the altered biomarker profile might eventually be used to characterize RV condition, its stage of adaptation and serve as pillar in directing follow-up and therapeutic interventions. In figure 3 , we present a hypothetical algorithm to recognize abnormal RV loading, RV remodelling and associated processes.