LAUSR

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 morbidity and mortality and frequently used in symptomatic and/or hospitalized adults with congenital heart disease (ACHD). Their prognostic value in clinically stable ACHD is not yet well established. This study investigates the predictive value of hs-TnT, NT-proBNP and CRP for survival and cardiovascular 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 cardiovascular events. Survival analyses was 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 = .005) and NT-proBNP (p = .018) as independent predictors of death or cardiac-related events in stable ACHD, whilst the prognostic value of CRP vanished after multivariable adjustment (p = .057). ROC 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 (CI 3.57-16.40, p < 0.001) higher risk for death and cardiac-related events compared to 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.