End-stage heart failure in congenitally corrected transposition of the great arteries: a multicentre study.
Adult
Humans
Female
Child
Young Adult
Middle Aged
Male
Congenitally Corrected Transposition of the Great Arteries
Retrospective Studies
Transposition of Great Vessels
/ complications
Tricuspid Valve Insufficiency
/ complications
Ventricular Dysfunction, Right
/ complications
Heart Failure
/ complications
Adult congenital heart disease
Congestive heart failure
Heart transplantation
Mechanical circulatory support
Systemic right ventricle
Transposition of the great arteries
Journal
European heart journal
ISSN: 1522-9645
Titre abrégé: Eur Heart J
Pays: England
ID NLM: 8006263
Informations de publication
Date de publication:
07 09 2023
07 09 2023
Historique:
received:
24
11
2022
revised:
19
05
2023
accepted:
25
07
2023
medline:
8
9
2023
pubmed:
18
8
2023
entrez:
18
8
2023
Statut:
ppublish
Résumé
For patients with congenitally corrected transposition of the great arteries (ccTGA), factors associated with progression to end-stage congestive heart failure (CHF) remain largely unclear. This multicentre, retrospective cohort study included adults with ccTGA seen at a congenital heart disease centre. Clinical data from initial and most recent visits were obtained. The composite primary outcome was mechanical circulatory support, heart transplantation, or death. From 558 patients (48% female, age at first visit 36 ± 14.2 years, median follow-up 8.7 years), the event rate of the primary outcome was 15.4 per 1000 person-years (11 mechanical circulatory support implantations, 12 transplantations, and 52 deaths). Patients experiencing the primary outcome were older and more likely to have a history of atrial arrhythmia. The primary outcome was highest in those with both moderate/severe right ventricular (RV) dysfunction and tricuspid regurgitation (n = 110, 31 events) and uncommon in those with mild/less RV dysfunction and tricuspid regurgitation (n = 181, 13 events, P < .001). Outcomes were not different based on anatomic complexity and history of tricuspid valve surgery or of subpulmonic obstruction. New CHF admission or ventricular arrhythmia was associated with the primary outcome. Individuals who underwent childhood surgery had more adverse outcomes than age- and sex-matched controls. Multivariable Cox regression analysis identified older age, prior CHF admission, and severe RV dysfunction as independent predictors for the primary outcome. Patients with ccTGA have variable deterioration to end-stage heart failure or death over time, commonly between their fifth and sixth decades. Predictors include arrhythmic and CHF events and severe RV dysfunction but not anatomy or need for tricuspid valve surgery.
Sections du résumé
BACKGROUND AND AIMS
For patients with congenitally corrected transposition of the great arteries (ccTGA), factors associated with progression to end-stage congestive heart failure (CHF) remain largely unclear.
METHODS
This multicentre, retrospective cohort study included adults with ccTGA seen at a congenital heart disease centre. Clinical data from initial and most recent visits were obtained. The composite primary outcome was mechanical circulatory support, heart transplantation, or death.
RESULTS
From 558 patients (48% female, age at first visit 36 ± 14.2 years, median follow-up 8.7 years), the event rate of the primary outcome was 15.4 per 1000 person-years (11 mechanical circulatory support implantations, 12 transplantations, and 52 deaths). Patients experiencing the primary outcome were older and more likely to have a history of atrial arrhythmia. The primary outcome was highest in those with both moderate/severe right ventricular (RV) dysfunction and tricuspid regurgitation (n = 110, 31 events) and uncommon in those with mild/less RV dysfunction and tricuspid regurgitation (n = 181, 13 events, P < .001). Outcomes were not different based on anatomic complexity and history of tricuspid valve surgery or of subpulmonic obstruction. New CHF admission or ventricular arrhythmia was associated with the primary outcome. Individuals who underwent childhood surgery had more adverse outcomes than age- and sex-matched controls. Multivariable Cox regression analysis identified older age, prior CHF admission, and severe RV dysfunction as independent predictors for the primary outcome.
CONCLUSIONS
Patients with ccTGA have variable deterioration to end-stage heart failure or death over time, commonly between their fifth and sixth decades. Predictors include arrhythmic and CHF events and severe RV dysfunction but not anatomy or need for tricuspid valve surgery.
Identifiants
pubmed: 37592821
pii: 7244786
doi: 10.1093/eurheartj/ehad511
pmc: PMC10482567
doi:
Types de publication
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
3278-3291Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
Circulation. 2016 Feb 23;133(8):770-801
pubmed: 26787728
Am Rev Respir Dis. 1984 Feb;129(2 Pt 2):S49-55
pubmed: 6421218
Int J Cardiol. 2014 Feb 1;171(2):184-91
pubmed: 24374205
Chest. 1992 May;101(5):1382-5
pubmed: 1582301
J Thorac Cardiovasc Surg. 1995 Apr;109(4):642-52; discussion 652-3
pubmed: 7715211
Int J Cardiol. 2018 May 1;258:83-89
pubmed: 29463466
Int J Cardiol. 2015 Oct 1;196:1-6
pubmed: 26070176
Circulation. 1998 Sep 8;98(10):997-1005
pubmed: 9737520
J Am Coll Cardiol. 2016 Aug 30;68(9):908-17
pubmed: 27561764
Circulation. 2019 Apr 2;139(14):e801-e813
pubmed: 30586770
Hellenic J Cardiol. 2005 Sep-Oct;46(5):370-3
pubmed: 16295949
JACC Cardiovasc Imaging. 2022 Apr;15(4):566-574
pubmed: 34801447
J Am Coll Cardiol. 2019 Apr 2;73(12):1494-1563
pubmed: 30121240
J Heart Lung Transplant. 2018 Jan;37(1):89-99
pubmed: 28365175
J Am Coll Cardiol. 2000 Jul;36(1):255-61
pubmed: 10898443
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2019;22:66-73
pubmed: 31027567
Eur Heart J Cardiovasc Imaging. 2022 Apr 18;23(5):680-688
pubmed: 34059878
Open Heart. 2016 Jul 11;3(2):e000407
pubmed: 27493760
J Heart Lung Transplant. 2013 Nov;32(11):1059-64
pubmed: 23921356
Am Heart J. 1989 Sep;118(3):526-30
pubmed: 2773773
Eur Heart J. 2022 Jul 21;43(28):2685-2694
pubmed: 35673927
J Am Coll Cardiol. 2022 Sep 6;80(10):951-963
pubmed: 36049802
J Am Coll Cardiol. 2011 May 17;57(20):2008-17
pubmed: 21565637
Eur Heart J. 2021 Feb 11;42(6):563-645
pubmed: 32860028