IMR Press / RCM / Volume 24 / Issue 3 / DOI: 10.31083/j.rcm2403085
Open Access Original Research
Predictors of Developing Heart Failure in Adults with Congenital Heart Defects
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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
*Correspondence: (Kambiz Norozi)
These authors contributed equally.
Rev. Cardiovasc. Med. 2023, 24(3), 85;
Submitted: 26 November 2022 | Revised: 16 January 2023 | Accepted: 30 January 2023 | Published: 8 March 2023
(This article belongs to the Special Issue Adult Congenital Heart Disease: Diagnosis, Prognosis and Management)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

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 (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. 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, 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. Conclusions: 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.

adult congenital heart disease
heart failure
exercise testing
WE 2670/1–1/Deutsche Forschungsgemeinschaft DFG
GE1167/2–1/Deutsche Forschungsgemeinschaft DFG
W-GÖ-014/2016/Stiftung Kinderherzen
Fig. 1.
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