Prognostic value of serial NT-proBNP assay in adults with congenital heart disease and biventricular physiology

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Congenital heart disease with biventricular physiology (n=3674). Intervention: Temporal increase in serial NT-proBNP levels vs. Single baseline NT-proBNP measurement or conventional clinical indices. Primary outcome: All-cause mortality (HR 2.82, 95% CI 1.03-6.52, p=0.02).

Q: What does this research mean for the field?

Serial NT-proBNP measurement provides superior prognostic value for all-cause mortality compared to single baseline measurements and conventional clinical indices in adults with congenital heart disease and biventricular physiology. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mohamed Ellabbad; Marwan Ahmed; Ahmed E. Ali; Maan Jokhadar; David S. Majdalany; Alexander C. Egbe

doi:10.1016/j.ijcchd.2026.100699

July 23, 2026International Journal of Cardiology Congenital Heart DiseaseOpen Access

Prognostic value of serial NT-proBNP assay in adults with congenital heart disease and biventricular physiology

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Key result

Temporal increase in NT-proBNP is linked to a ~180% higher risk of all-cause mortality.

HR 2.82
95% CI 1.03-6.52
P=0.02
n=3,674

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Why the study?

Available data regarding the prognostic role of NT-proBNP in adults with congenital heart disease are limited by small sample sizes and brief follow-up.

Does serial NT-proBNP measurement improve prognostic performance for all-cause mortality compared to single baseline measurement in adults with congenital heart disease and biventricular physiology?

Key Points

To assess the prognostic value of baseline and serial NT-proBNP measurements for predicting all-cause mortality in a large cohort of adults with congenital heart disease.
Retrospective cohort study of 3674 adults (mean age 42 ± 16 years; 47% male) with congenital heart disease, biventricular physiology, and systemic morphologic left ventricle who had ≥2 NT-proBNP measurements between 2003 and 2023.
Median follow-up was 6.7 years from the second measurement, evaluating both baseline levels and relative temporal changes (relative Δ_NT-proBNP) separated by a mean interval of 11 ± 3 months.
All-cause mortality occurred in 431 (12%) patients, with both baseline NT-proBNP (adjusted HR 1.48, 95% CI [1.07, 2.05], p = 0.009) and temporal increase (adjusted HR 2.82, 95% CI [1.03, 6.52], p = 0.02) independently predicting death.
Combining baseline levels and temporal change improved risk discrimination (c-statistic increased from 0.761 to 0.786, difference +0.025 [95% CI 0.007, 0.043], p = 0.01), outperforming echocardiographic, invasive hemodynamic, and exercise indices.

Study Design

Type

Cohort (n=3,674)

Multicenter

No

Structured PICO

Does serial NT-proBNP measurement improve prognostic performance for all-cause mortality compared to single baseline measurement in adults with congenital heart disease and biventricular physiology?

P

Population

3,674 adults with congenital heart disease and biventricular physiology, mean age 42, 53% female, followed for a median of 6.7 years.

E

Exposure

Serial NT-proBNP measurements (temporal change calculated as relative change from baseline levels)

C

Comparator

Single (baseline) NT-proBNP measurement and conventional clinical indices (echocardiographic, invasive hemodynamic, and exercise test indices)

O

Outcome

All-cause mortality assessed as time-to-event outcome from the date of the second NT-proBNP assayhard clinical

Main Result

Hazard Ratio: 2.82 (95% CI 1.03–6.52)

p-value: p=0.02

Serial NT-proBNP measurement provides incremental prognostic value over a single baseline measurement and conventional clinical indices for predicting all-cause mortality in adults with congenital heart disease and biventricular physiology.

Limitations

Retrospective single-center study prone to selection and ascertainment bias
NT-proBNP was not measured in all patients, but at the discretion of the primary cardiologist
Did not account for changes in medical therapy including diuretics between measurements
NT-proBNP not measured in all patients, but in selected patients at the discretion of the primary cardiologist
Did not account for changes in medical therapy including diuretics which could have influenced loading conditions

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Implication

May support serial NT-proBNP for mortality prognostication in adult congenital heart disease; extends prior cohorts but leaves open prospective validation.

Abstract

Background: The available data about the prognostic role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in adults with congenital heart disease (CHD) are derived from small sample size with limited follow-up. The purpose of this study was to assess the role of NT-proBNP assay for prognostication in adults with CHD based on a large cohort. Method: Retrospective cohort study of adults with CHD, biventricular physiology, and systemic morphologic left ventricle who had ≥2 NT-proBNP measurements (2003-2023). Temporal change in NT-proBNP was calculated as relative change from baseline levels (relative Δ_NT-proBNP). Results: Of 3674 patients (age 42 ± 16 years; 47% males), median baseline and follow-up NT-proBNP levels were 178 (72; 539) pg/ml and 236 (103; 854) pg/ml, respectively. The relative Δ_NT-proBNP was 22% (-9, 51), and 2496 (68%) had temporal increase in NT-proBNP levels (i.e., relative Δ_NT-proBNP >0). The correlates of higher baseline NT-proBNP measurement were older age, atrial fibrillation, hepatorenal dysfunction, biventricular systolic dysfunction, and elevated biventricular filling pressures. Overall, 431 (12%) patients died during median follow-up. Both baseline NT-proBNP level and temporal increase in NT-proBNP were associated with all-cause mortality in all patient subgroups. Serial NT-proBNP measurement had superior prognostic value compared to single (baseline) NT-proBNP measurements and had superior prognostic performance compared to conventional clinical indices (echocardiographic indices, invasive hemodynamic indices, exercise test indices). Conclusions: NT-proBNP assay is inexpensive, readily available, and noninvasive, making it ideal for longitudinal monitoring. Further studies are required to determine whether NT-proBNP data can be used to guide therapeutic interventions in this population.

Discussion

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Cite This Study

Ellabbad et al. (2026) conducted a cohort in Congenital heart disease with biventricular physiology (n=3,674). Temporal increase in serial NT-proBNP levels vs. Single baseline NT-proBNP measurement or conventional clinical indices was evaluated on All-cause mortality (HR 2.82, 95% CI 1.03-6.52, p=0.02). Temporal increase in NT-proBNP levels was significantly associated with all-cause mortality (HR 2.82) and provided superior prognostic value compared to single baseline measurements.

synapsesocial.com/papers/6a86a9a0fd179ab3599eaa40 https://doi.org/10.1016/j.ijcchd.2026.100699

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Prognostic value of serial NT-proBNP assay in adults with congenital heart disease and biventricular physiology

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prognostic value of serial NT-proBNP assay in adults with congenital heart disease and biventricular physiology

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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