Key result
Elevated hs-TnT (>9 ng/L) and NT-proBNP (>200 ng/L) in stable adults with congenital heart disease were associated with a 7.7-fold higher risk of death or cardiac events (95% CI 3.57-16.40; P<0.001).
Why the study?
The prognostic value of hs-TnT, NT-proBNP, and CRP in clinically stable adults with congenital heart disease was not yet well established.
Do hs-TnT and NT-proBNP predict survival and cardiac-related events in stable adults with congenital heart disease?
Cohort (n=495)
Do hs-TnT and NT-proBNP predict survival and cardiac-related events in stable adults with congenital heart disease?
Hazard Ratio: 7.7 (95% CI 3.57–16.4)
p-value: p=<0.001
Subclinical elevations of hs-TnT and NT-proBNP independently predict adverse cardiac events and mortality in stable outpatient adults with congenital heart disease.
AIMS: High-sensitive troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP) are established prognostic biomarkers for cardiovascular (CV) morbidity and mortality and frequently used in symptomatic and/or hospitalized adults with congenital heart disease (ACHD). Their prognostic value in clinically stable ACHD has not yet been well established. This study investigates the predictive value of hs-TnT, NT-proBNP, and CRP for survival and CV events in stable ACHD. METHODS AND RESULTS: In this prospective cohort study, 495 outpatient ACHD (43.9 ± 10.0 years, 49.1% female) underwent venous blood sampling including hs-TnT, NT-proBNP, and CRP. Patients were followed up for survival status and the occurrence of CV events. Survival analyses were performed with Cox proportional hazards regression analysis and Kaplan-Meier curves. During a mean follow-up of 2.8 ± 1.0 years, 53 patients (10.7%) died or reached a cardiac-related endpoint including sustained ventricular tachycardia, hospitalization with cardiac decompensation, ablation, interventional catheterization, pacer implantation, or cardiac surgery. Multivariable Cox regression revealed hs-TnT (P = 0.005) and NT-proBNP (P = 0.018) as independent predictors of death or cardiac-related events in stable ACHD, whilst the prognostic value of CRP vanished after multivariable adjustment (P = 0.057). Receiver-operator characteristic curve analysis identified cut-off values for event-free survival of hs-TnT ≤9 ng/L and NT-proBNP ≤200 ng/L. Patients with both increased biomarkers had a 7.7-fold (confidence interval 3.57-16.40, P < 0.001) higher risk for death and cardiac-related events compared with patients without elevated blood values. CONCLUSION: Subclinical values of hs-TnT and NT-proBNP are a useful, simple, and independent prognostic tool for adverse cardiac events and survival in stable outpatient ACHD. REGISTRATION: German Clinical Trial Registry DRKS00015248.
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Willinger et al. (2023) conducted a cohort in Stable adults with congenital heart disease (ACHD) (n=495). Elevated hs-TnT (>9 ng/L) and NT-proBNP (>200 ng/L) vs. Patients without elevated blood values was evaluated on Death or cardiac-related events (sustained ventricular tachycardia, hospitalization with cardiac decompensation, ablation, interventional catheterization, pacer implantation, or cardiac surgery) (HR 7.7, 95% CI 3.57-16.40, p=<0.001). Elevated hs-TnT (>9 ng/L) and NT-proBNP (>200 ng/L) in stable adults with congenital heart disease were associated with a 7.7-fold higher risk of death or cardiac events (95% CI 3.57-16.40; P<0.001).
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