Abstract 12401: Soluble Fms-like Tyrosine Kinase 1 and Placental Growth Factor Ratio - A Novel Biomarker for Assessing Congestion and Angiogenesis in Children With Congenital Heart Disease
Background: Serum levels of soluble fms-like tyrosine kinase 1 (sFlt-1), an antiangiogenic factor, and its binding protein, placental growth factor(PlGF), are altered in women with preeclampsia. Recently, the sFlt-1/PlGF ratio has been known to predict not only the occurrence of preeclampsia but also that of heart failure in adults. However, few reports have described the use of the sFlt-1/PlGF ratio for evaluating abnormal hemodynamic loads in children with congenital heart disease (CHD).
Methods: Serum sFlt-1 and PlGF levels were determined in 20 children with atrial septal defects (ASD), 32 children with ventricular septal defects (VSD), 21 children with tetralogy of Fallot (ToF), 19 children who were Fontan candidates (Fontan), and 77 healthy controls. The pre- and post-surgical levels of sFlt-1 and PlGF were compared in the children with CHD.
Results: The pre-surgical levels of the sFlt-1/PlGF ratios in the ASD, VSD, and Fontan children were significantly higher than those in the controls (Figure; white boxes). Furthermore, the sFlt-1/PlGF ratios were significantly decreased after surgical repair in the ASD and VSD children. In the ToF children, the serum sFlt-1/PlGF ratio was highest after palliative surgery (BT-shunt) and second highest after radical surgery (intra-cardiac repair) as compared to the pre-surgical levels (125 and 84 vs. 19, respectively). In the Fontan children, the serum sFlt-1/PlGF ratio was highest after palliative surgery (Glenn shunt) and much lower after radical surgery (Fontan procedure) as compared to the pre-surgical levels (170 and 12 vs. 136, respectively).
Conclusion: Our study clearly demonstrated that the sFlt-1/PlGF ratio indicated congestive heart failure in children with CHD. In addition, the sFlt-1/PlGF ratio may indicate persistent cyanosis and angiogenesis in children after palliative surgery. These findings may prove useful in the management of CHD.
- © 2013 by American Heart Association, Inc.