Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide, Troponin-T, and Growth-Differentiation Factor 15 in Adult Congenital Heart Disease

• Published in: Circulation (New York, N.Y.) N.Y.), 2017-01, Vol.135 (3), p.264-279
• Main Authors: Baggen, Vivan J.M, van den Bosch, Annemien E, Eindhoven, Jannet A, Schut, Anne-Rose W, Cuypers, Judith A.A.E, Witsenburg, Maarten, de Waart, Monique, van Schaik, Ron H.N, Zijlstra, Felix, Boersma, Eric, Roos-Hesselink, Jolien W
• Format: Article
• Language: English
• Subjects: Adult; Cohort Studies; Echocardiography - methods; Female; Growth Differentiation Factor 15 - metabolism; Heart Defects, Congenital - blood; Humans; Male; Natriuretic Peptide, Brain - metabolism; Peptide Fragments - metabolism; Prognosis; Prospective Studies; Troponin T - metabolism
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.116.023255

BACKGROUND:The number of patients with adult congenital heart disease (ACHD) is rapidly increasing. To optimize patient management, there is a great need to accurately identify high-risk patients. Still, no biomarker has been firmly established as a clinically useful prognostic tool in this group. We studied the association of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitive troponin-T, and growth-differentiation factor 15 with cardiovascular events in ACHD. METHODS:Clinically stable patients with ACHD who routinely visited the outpatient clinic between April 2011 and April 2013 underwent clinical assessment, electrocardiography, echocardiography, and biomarker measurement (NT-proBNP, high-sensitive troponin-T, and growth-differentiation factor 15) at the time of study inclusion. Patients were prospectively followed for the occurrence of cardiovascular events (death, heart failure, hospitalization, arrhythmia, thromboembolic events, and reintervention). Survival curves were derived by the Kaplan-Meier method, and Cox regression was performed to investigate the relation between biomarkers and events with adjustment for multiple clinical and echocardiographic variables. RESULTS:In total, 595 patients were included (median age, 33 years; interquartile range, 25–41 years; 58% male; 90% New York Heart Association class I). Patients were followed during a median of 42 (interquartile range, 37–46) months. Of the 3 evaluated biomarkers, NT-proBNP in the upper quartile (>33.3 pmol/L) was most strongly associated with cardiovascular events (n=165, adjusted hazard ratio, 9.05 [3.24–25.3], P14 ng/L), and elevated growth-differentiation factor 15 (>1109 ng/L) identified those patients at highest risk of cardiovascular events (log-rank P