Dynamics of matrix metalloproteinases and procollagen type-1 N-terminal propeptide following right ventricular outflow tract reconstruction: the protective mechanism of restrictive physiology

Aslan M., BENLİ O., Gocen U., Atalay A., Yüksel M., Poyrazoglu H., ...Daha Fazla

Cardiology in the Young, 2026 (SCI-Expanded, Scopus) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Basım Tarihi: 2026
  • Doi Numarası: 10.1017/s1047951126111615
  • Dergi Adı: Cardiology in the Young
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE
  • Anahtar Kelimeler: biological banding, matrix metalloproteinases, restrictive physiology, tetralogy of Fallot, ventricular remodelling
  • Çukurova Üniversitesi Adresli: Evet

Özet

Objective: Right ventricular outflow tract reconstruction frequently leads to long-term pulmonary failure and ventricular dilation. This study aims to investigate the dynamics of matrix metalloproteinase-2, matrix metalloproteinase-9, and procollagen type-1 N-terminal propeptide in predicting postoperative remodelling and to evaluate the “protective” potential of restrictive right ventricular physiology. Methods: This prospective comparative cohort study included 20 patients undergoing right ventricular outflow tract reconstruction (Research Group) and 20 patients undergoing atrial or ventricular septal defect repair via transatrial approach (Control Group). Biomarker levels were measured using ELISA at preoperative, early postoperative (24–48 hours), and 6-month intervals. Right ventricular geometry was assessed with cross-sectional snapshots at 6 months and 10 years. Right ventricular dilation was defined as right ventricular end-diastolic volume index > 150 ml/m2 or diameter z-score > 2, while preserved geometry was defined as right ventricular end-diastolic volume index < 100 ml/m2 or diameter z-score < 1.5. Results: Early postoperative biomarker increases were similar (p = 0.310) but differed significantly at 6 months. In the study group, matrix metalloproteinase-2 (p < 0.001) and procollagen type-1 N-terminal propeptide (p = 0.001) levels remained significantly elevated, independent of pulmonary regurgitation severity (p > 0.05). Ten years later, restrictive physiology was observed in 10 patients (50%), representing a progression compared to the 8 patients identified at 6 months. Conclusion: Persistent elevation of matrix metalloproteinase-2 and procollagen type-1 N-terminal propeptide reflects an active “remodeling” process. Restrictive physiology is associated with the “Biological Banding” mechanism. By increasing myocardial stiffness, this adaptive process is linked to protecting the right ventricle from irreversible dilation under chronic volume overload.