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We hypothesized that biomarkers of myocardial fibrosis and stretch would be correlated with worse mid-term RV function measured by strain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included children repaired at our institution from 2016 to 2019. Biomarkers measured preoperatively included galectin-3, Procollagen-type-I carboxy-terminal-propeptide (PICP), Procollagen-type-III-amino-terminal-propeptide (PIIINP), matrix-metalloproteinase-1 (MMP1), matrix-metalloproteinase-9 (MMP9), soluble suppression of tumorigenicity-2 (sST2), and N-terminal-pro-B-type-natriuretic-peptide (NT pro-BNP). Function was retrospectively assessed with RV longitudinal peak systolic strain (RVLS), free-wall peak systolic strain (FWS), peak systolic strain-rate (SR) and free-wall systolic strain-rate (FWSR) on available echocardiograms from one to five years after repair. Multivariable linear regression models with Generalized Estimating Equations tested whether preoperative biomarkers were associated with RV strain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 56 patients were followed with 198 reviewed echocardiograms, with a median of 4 echocardiograms per patient (range 1\u20135). Strain parameters remained stable until year 2 followed by a significant decrease in all parameters by year 3 through year 5. Higher preoperative levels of MMP1, PICP and PIIINP were associated with worse RVLS. Higher NT-proBNP was associated with better FWSR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RV function is dynamic in the first 5 years after TOF repair but remains stable in the mid-term. Preoperative biomarkers of extracellular matrix turnover could help explain postoperative RV function in patients with TOF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10554-025-03533-4","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T08:02:13Z","timestamp":1761552133000},"page":"2229-2239","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of preoperative Circulating biomarkers with echocardiographic measures of right ventricular strain five years after tetralogy of fallot repair"],"prefix":"10.1007","volume":"41","author":[{"given":"Jose A.","family":"Galan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer A.","family":"Faerber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea L.","family":"Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryusuke","family":"Numata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angeli","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anh Duc","family":"Mai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam S.","family":"Himebauch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique M.","family":"Gardner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Mercer-Rosa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"issue":"9","key":"3533_CR1","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1016\/j.echo.2010.06.008","volume":"23","author":"MCK Farah","year":"2010","unstructured":"Farah MCK, Castro CRP, Moreira V, de Binotto M, Guerra MA, de Riso VC (2010) The impact of preexisting myocardial remodeling on ventricular function early after tetralogy of fallot repair. 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