■成人先天性心脏病(ACHD)人口正在增长,风险预测对于预测不良结局和在患者生命周期中咨询患者非常重要。
■本研究旨在描述血液生物标志物在ACHD中的长期预后价值。
■在这项前瞻性观察性队列研究中,602名中度或复杂ACHD患者纳入研究(中位年龄32.5岁[IQR:24.7-41.2],42%为女性,90%纽约心脏协会I)。N末端脑钠肽前体(NT-proBNP),高敏肌钙蛋白T,生长分化因子15,高敏C反应蛋白,抑制致瘤性-2和半乳糖凝集素-3,以及全血细胞计数,肾功能,LDL,和HDL进行测量。应用Cox模型将选定的生物标志物与全因死亡率的主要终点和死亡率或心力衰竭的次要终点相关联。根据相关预后因素调整后的标准化HR,包括年龄,性别,诊断的复杂性,被报道。
■在424名(70.4%)患者中存在异常的生物标志物水平。在平均10.1年的随访中,41例(6.8%)患者死亡,81例(13.5%)发生心力衰竭。观察到主要和次要终点与红细胞分布宽度之间的关联,NT-proBNP,和生长分化因子15。在多生物标志物模型中,只有NT-proBNP与死亡率相关(HR:2.74;95%CI:2.01-3.74).NT-proBNP显著改善了临床预测模型的C统计量(0.85-0.92)。仅基于NT-proBNP,可以识别低风险患者。NT-proBNP<76ng/L的患者10年无心力衰竭生存率为98.5%。
■血液生物标志物在ACHD中具有预后价值。NT-proBNP改善了风险预测,能够识别低危患者。它的常规使用应在ACHD中实施。
UNASSIGNED: The adult congenital heart disease (ACHD) population is growing and risk prediction is important to predict adverse outcome and consult patients during their lifecourse.
UNASSIGNED: This study aims to describe the long-term prognostic value of blood biomarkers in ACHD.
UNASSIGNED: In this prospective observational cohort study, 602 patients with moderate or complex ACHD were included (median age 32.5 years [IQR: 24.7-41.2], 42% female, 90% New York Heart Association I). N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive-troponin T, growth differentiation factor 15, high-sensitive-C-reactive protein, suppression of tumorigenicity-2 and galectin-3, as well as full blood count, renal function, LDL, and HDL were measured. Cox models were applied to relate the selected biomarkers with the primary end point of all-cause mortality and secondary end point of mortality or heart failure. Standardized HRs adjusted for relevant prognostic factors, including age, sex, and complexity of diagnosis, were reported.
UNASSIGNED: Abnormal biomarker levels were present in 424 (70.4%) patients. During a median follow-up of 10.1 years, 41 (6.8%) patients died and 81 (13.5%) developed heart failure. Associations were observed between the primary and secondary end point and red cell distribution width, NT-proBNP, and growth differentiation factor 15. In a multibiomarker model, only NT-proBNP remained associated with mortality (HR: 2.74; 95% CI: 2.01-3.74). NT-proBNP significantly improved the C-statistic of the clinical prediction model (0.85-0.92). Based on NT-proBNP alone, low-risk patients could be identified. Patients with NT-proBNP <76 ng/L showed a 10-year heart failure-free survival of 98.5%.
UNASSIGNED: Blood biomarkers have prognostic value in ACHD. NT-proBNP improves risk prediction and is able to identify low-risk patients. Its routine use should be implemented in ACHD.