Predictors of Developing Heart Failure in Adults with Congenital Heart Defects

Kambiz Norozi; Matthias J Müller; Chuce Xing; Michael R Miller; Jonas Bock; Thomas Paul; Siegfried Geyer; Claudia Dellas

doi:10.31083/j.rcm2403085

Predictors of Developing Heart Failure in Adults with Congenital Heart Defects

Rev Cardiovasc Med. 2023 Mar 8;24(3):85. doi: 10.31083/j.rcm2403085. eCollection 2023 Mar.

Authors

Kambiz Norozi^{1

2

3

4}, Matthias J Müller², Chuce Xing¹, Michael R Miller^{1

4}, Jonas Bock², Thomas Paul², Siegfried Geyer⁵, Claudia Dellas²

Affiliations

¹ Department of Pediatrics, Pediatric Cardiology, Western University, London, ON N6A 3K7, Canada.
² Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center, 37075 Goettingen, Germany.
³ Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany.
⁴ Children Health Research Institute, London, ON N6A 5W9, Canada.
⁵ Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany.

Abstract

Background: 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.

Objectives: 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.

Methods: 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 ( ${VO}_{2max}$ ) 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.

Results: 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, ${VO}_{2max}$ $<$ 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.

Conclusions: In this cohort of ACHD patients, the combination of ${VO}_{2max%}$ , 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.

Keywords: adult congenital heart disease; echocardiography; exercise testing; heart failure.

Grants and funding

This manuscript is based on two research projects: the first was funded by the German Research Foundation (Deutsche Forschungsgemeinschaft DFG; grant numbers WE 2670/1–1 and GE1167/2–1. The follow-up study was funded by Stiftung Kinderherzen, grant number W-GÖ-014/2016 (URL: https://www.kinderherzen.de).