Congenital heart disease
Incidence and Risk Distribution of Heart Failure in Adolescents and Adults With Congenital Heart Disease After Cardiac Surgery

https://doi.org/10.1016/j.amjcard.2005.10.065Get rights and content

Heart failure (HF) is a major problem in the long-term follow-up of adults with congenital heart disease (CHD) after cardiac surgery. The purpose of this study was to evaluate risk factors for HF in patients with CHD. N-terminal–pro-brain natriuretic peptide and maximal oxygen uptake (VO2max) were measured in 345 consecutive patients with CHD. HF was defined as an elevated N-terminal–pro-brain natriuretic peptide level (≥100 pg/ml) and reduced VO2max (≤25 ml/kg/min). The HF criteria were met by 89 patients. These patients were significantly older (mean ± SEM 30.8 ± 0.9 vs 24.8 ± 0.5 years), had significantly lower maximal heart rates (149 ± 3 vs 164 ± 1 beats/min), and had larger end-diastolic right ventricular diameters (36 ± 1 vs 27 ± 1 mm) and right ventricular pressure estimated by Doppler flow velocities of tricuspid valve regurgitation (2.9 ± 0.1 vs 2.3 ± 0.03 m/s). Mean fractional shortening of the left ventricle was within the normal range. To estimate risk stratification, odds ratios for HF were determined for the most frequently occurring types of congenital heart defects and surgical procedures. In conclusion, HF in adults with CHD predominately depends on diagnosis, age, the frequency of reoperation, and right ventricular function and may be related to chronotropic incompetence indicated by lower maximal heart rates.

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Patients

From May 1, 2003, to May 31, 2004, we evaluated the cardiocirculatory status of 345 patients with CHD (141 female patients, 204 male patients). This group included adolescent and adult patients ranging in age from 14 to 50 years. On the basis of their original heart defects, patients were divided into 7 groups (Table 1). The left-to-right shunt (LRS) group included patients operated on to correct uncomplicated atrial or ventricular septal defects and patent ductus arteriosus Botalli. The

Results

Of the enrolled patients, 196 were in New York Heart Association (NYHA) functional class I, 132 in NYHA class II, 16 in NYHA class III, and 1 in NYHA class IV. Eighty-nine of the 345 study patients (26%) fulfilled the HF criteria defined previously. As Table 2 demonstrates, patients with HF were significantly older (30.8 ± 0.9 vs 24.8 ± 0.5 years), their age at operation was on average 2.7 years greater, and their frequency of reoperations was significantly greater compared with patients

Discussion

In our study group, 89 patients (26%) had significantly elevated NT–pro-BNP plasma levels and reduced VO2max. If NT–pro-BNP plasma levels can differentiate between cardiac and pulmonary causes of exercise intolerance,19, 20, 21 reduced VO2max in these patients may be predominantly caused by HF. Compared with patients with LRS, the calculated ORs (Table 3) show that HF in adults with CHD predominantly occurred in patients with TOF, single ventricles, and after the Mustard operation for TGA. The

Acknowledgment

We thank Barbara Formanek, who worked as a study nurse, and Renate Lucyga, MTA, Ursula Baumgarten, MTA, and Sabine Laurenzano, MTA, for expert technical assistance during this study.

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    Dr. Wessel was supported in part by Grant Nr. WE 2670/1-1 and Dr. Geyer was supported in part by Grant Nr. GE 1167/3-1 from the German Research Foundation, Bonn, Germany. Dr. Buchorn was supported in part by grants from HERZKIND e.v., Braunschweig, Germany.

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