Abstract 2137: Natriuretic Peptide Levels Predict Mortality in Adults With Congenital Heart Disease
Introduction Neurohormonal activation is prevalent in adults with congenital heart disease (ACHD) but its relation to outcome remains unknown.
Objectives We hypothesized that natriuretic peptide levels are strong predictors of outcome in ACHD.
Methods B-type natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) were measured prospectively in 49 ACHD patients, followed for a median of 7.9 years (interquartile range [IQR] 7.7– 8.2 years). Cox proportional hazards regression was used to determine the relation of BNP and ANP concentrations to all-cause mortality.
Results Mean age at baseline was 33.8±11.1 years and 46.9% of patients were male. The majority of patients (77.5%) were symptomatic (20.4% NYHA class III/IV), 10 (20.4%) were cyanotic and 28 (57.1%) had systemic ventricular dysfunction (moderate or severe in 18.4%). Median concentration of BNP was 52.7 pg/ml (IQR 39.1–115.4 pg/ml) and ANP 47.4 pg/ml (IQR 19.7–112.8 pg/ml). Eleven (22.4%) patients died during follow up. Both BNP and ANP were strong predictors of mortality (HR per 100 pg/ml increase 1.80, 95%CI 1.38 –2.34, p146 pg/ml predicted death with a sensitivity of 72.7% and specificity 94.7% (AUC=0.89, p=0.0001). No patients with BNP <78 pg/ml died during follow-up (Figure⇓).
Conclusions BNP and ANP levels strongly relate to the risk of death in ACHD over mid-term follow-up and could be used as a simple clinical marker for risk stratification in this population.