Predictors of Developing Heart Failure in Adults with Congenital Heart Defects

TL;DR

This study identifies key predictors of heart failure in adults with congenital heart defects over a 15-year period.

Contribution

The study identifies a combination of three clinical parameters as predictive of heart failure in ACHD patients.

Findings

NT-proBNP levels >1.7 times the upper normal limit predict heart failure.

VO2max <73% of predicted values is a significant predictor of heart failure.

QRS complex duration >120 ms is associated with increased risk of heart failure.

Abstract

The population of adults with congenital heart defects
(ACHD) is growing. The leading cause of premature death in these patients is
heart failure (HF). However, there is still limited information on the predictive
factors for HF in ACHD patients.

This study re-examined a
group of patients with repaired or palliated congenital heart defects (CHD) that
were initially studied in 2003. A follow-up period of 15 years has allowed us to
identify and evaluate predictors for the development of HF in ACHD.

All patients with repaired or palliated CHD who participated in
the initial study (n = 364) were invited for a follow-up examination. The effects
of maximum oxygen uptake (VO2max) during exercise stress testing, the
cardiac biomarker N-terminal pro brain natriuretic peptide (NT-proBNP), and QRS complex on the development of HF during the
follow-up period were investigated.

From May 2017 to April
2019, 249 of the initial 364 (68%) patients participated in the follow-up study.
Of these, 21% were found to have mild CHD, 60% had moderate CHD, and 19% had
complex CHD. Significant predictors for the development of HF were: NT-proBNP
level >1.7 times the upper normal limit, VO2max
<73% of predicted
values, and QRS complex duration >120 ms. Combination of these three parameters
resulted in the highest area-under-the-curve of 0.75, with a sensitivity of 75%
and specificity of 63% for predicting the development of HF.

In this cohort of ACHD patients, the combination of
VO2max%, NT-proBNP, and QRS duration was predictive of HF development over
a 15-year follow-up period. Enhanced surveillance of these parameters in patients
with ACHD may be beneficial for the prevention of HF and early intervention.

Figures