Baseline and Serial BNP Measurements Predict Long-Term Mortality in Adults with Congenital Heart Disease: A study including 3,392 patients

BackgroundAlthough there is an ever growing number of adult patients with congenital heart disease (ACHD), many are still afflicted by premature death. Previous reports suggested that natriuretic peptides may identify ACHD patients with adverse outcome. We investigated the prognostic power of brain natriuretic peptide (BNP) across the spectrum of ACHD in a large contemporary cohort. MethodsWe retrospectively studied 3,392 consecutive and well-characterised ACHD patients under long-term follow-up at a tertiary ACHD centre between 2006-2019. The primary study endpoint was all-cause mortality. ResultsA total of 11,974 BNP measurements were analysed. The median BNP at baseline was 47 [24-107] ng/L. During a median follow-up of 8.6 years (29,115 patient-years), 615 (18.1%) patients died. On univariate and multivariate analysis both baseline BNP and temporal changes in BNP levels were predictive of mortality (p<0.001 for both) independent of congenital heart disease diagnosis, complexity, anatomic/haemodynamic features, and/or systolic systemic ventricular function. Patients within the highest quartile of baseline BNP (>107 ng/L) and those within the highest quartile of temporal BNP change (>35 ng/L) had 5.8 and 3.6-fold increased risk of death, respectively. ConclusionBaseline BNP and temporal BNP changes are both significantly associated with all-cause mortality in ACHD independent of congenital heart disease diagnosis, complexity, anatomic/haemodynamic features, and/or systolic systemic ventricular function. BNP levels represent an easy to obtain and inexpensive marker conveying prognostic information and should be used for the routine surveillance of patients with ACHD.