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Prevalence and Prognostic Implications of Left Ventricular Systolic Dysfunction in Adults With Congenital Heart

Alexander C Egbe1, William R Miranda1, Patricia A Pellikka1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Journal of the American College of Cardiology
|April 8, 2022
PubMed

Insights

Left ventricular systolic dysfunction (LVSD) affects 12% of adults with congenital heart disease (CHD), particularly those with right-sided lesions. Cardiac therapies like guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT) improved left ventricular ejection fraction (LVEF).

Area of Science:

  • Cardiology
  • Congenital Heart Disease
  • Cardiovascular Medicine

Background:

  • Left ventricular systolic dysfunction (LVSD) and its treatment are well-documented in acquired heart disease, but less so in adults with congenital heart disease (CHD).
  • Limited data exist on the prevalence, risk factors, and prognostic implications of LVSD in adults with CHD.
  • Understanding the impact of cardiac therapies on LVSD in this population is crucial for improving patient outcomes.

Purpose of the Study:

  • To determine the prevalence of LVSD in adults with CHD.
  • To identify risk factors associated with LVSD in adults with CHD.
  • To evaluate the prognostic implications of LVSD and the effectiveness of guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT) on LVSD in adults with CHD.

Main Methods:

  • Retrospective study of adults with CHD and systemic left ventricle (LV) from 2003 to 2019.
  • LVSD defined as left ventricular ejection fraction (LVEF) <52% (men) or <54% (women).
  • Cardiovascular events included heart failure hospitalization, heart transplant, or cardiovascular death.

Main Results:

  • 12% (554/4,358) of adults with CHD had LVSD, with higher prevalence in right-sided lesions (15% vs 10%).
  • LVSD was independently associated with cardiovascular events (HR: 0.95; 95% CI: 0.93-0.97).
  • GDMT and CRT improved LVEF by 6% and 11%, respectively, and reduced N-terminal pro-hormone brain natriuretic peptide levels.

Conclusions:

  • LVSD is prevalent in 12% of adults with CHD, more common in right-sided lesions, and linked to adverse cardiovascular events.
  • GDMT and CRT demonstrate efficacy in improving LVEF in adults with CHD.
  • These findings support further clinical trials to validate the benefits of these therapies in CHD patients.
Abstract

Keywords:
cardiac therapycongenital heart diseaseleft ventricular systolic dysfunctionprognostication

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