AORTIC SURGERY IS ONE OF THE RISK FACTORS FOR ENHANCEMENT OF PRESSURE WAVE REFLECTION IN ADULT PATIENTS WITH CONGENITAL HEART DISEASE

AbstractBackground:Although sleep apnea is an important disorder associated with cardiac events, data regarding its prevalence and risk factors in adult patients with congenital heart disease are limited.Methods:In this study, patients underwent a sleep study in the hospital. Indications for admission were classified as heart failure, diagnostic catheterisation, interventional catheterisation, or arrhythmia. The prevalence, characteristics, and risk factors of sleep apnea using a type-3 portable overnight polygraph in adult patients with congenital heart disease were evaluated.Results:There were 104 patients [median age: 36 (interquartile range: 28–48) years] who were admitted for heart failure 34% (n = 36), diagnostic catheterisation 26% (n = 27), interventional catheterisation 18% (n = 19), or arrhythmia 22% (n = 23). The prevalence of sleep apnea, defined as a respiratory disturbance index ≥5, was 63% (n = 63), with a distribution of 37%, 16%, and 10% for mild (5≤ respiratory disturbance index <15), moderate (15≤ respiratory disturbance index <30), and severe (respiratory disturbance index ≥30) sleep apnea, respectively. A large majority of the sleep apnea cases were categorised as obstructive sleep apnea (92%, n = 58). The respiratory disturbance index ≥15 group had a significantly higher proportion of male patients and higher body mass index, noradrenaline level, and aortic blood pressure than the group without sleep apnea (respiratory disturbance index <5). Multivariable analysis showed that New York Heart Association class ≥II (OR, 4.36; 95% CI, 1.09–20.87) and body mass index ≥25 (OR, 4.29; 95% CI, 1.32–15.23) were independent risk factors for a respiratory disturbance index ≥15.Conclusion:Our results showed a high prevalence of sleep apnea in adult patients with congenital heart disease. Its unique haemodynamics may be associated with a high prevalence of sleep apnea. Congestive heart failure and being overweight are important risk factors for sleep apnea. Management of heart failure and general lifestyle improvements will be important for controlling sleep apnea symptoms in these patients.

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Abstract 15592: Role of Electroanatomic Voltage Mapping for Risk Stratification in Patients With Repaired Congenital Heart Disease Involving the Right Ventricle

Circulation ◽

10.1161/circ.132.suppl_3.15592 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Vincenzo Pazzano ◽

Rosalinda Palmieri ◽

Corrado Di Mambro ◽

Mario S Russo ◽

Massimo S Silvetti ◽

...

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Low Voltage ◽

Scar Tissue ◽

Adult Patients ◽

Surface Ecg ◽

Life Threatening ◽

History Of

Introduction: Among adult patients with previous surgical correction for Tetralogy of Fallot or other repaired Congenital Heart Disease (rCHD) involving the RV, ventricular arrhythmias (VA) and sudden cardiac death (SCD) represent a late complication. The imparied haemodynamics that lead to RV dilatation and overload could also alterate its electroanatomic structure. Hypothesis: 3D electroanatomic mapping (EAM) of the RV could confirm the presence of myocardial electrical abnormalities, allowing to better identify patients at risk for life-threatening arrhythmias. Methods: 146 patients (age 19.2 ±7.0) with rCHD involving the RV were selected from a population undergoing routine post-surgical follow-up, according to the presence of VA or severe RV dilatation. These patients underwent 3D EAM of the RV. We tested the correlation between size of scar tissue (areas with voltage < 0.5 mV) and several parameters universally accepted by the literature as risk factors for VA in this particular patient population. Results: In 125 (85.6%) patients, EAM demonstrated areas of low voltage in the antero-lateral RVOT. In 20 of these (16%, 13.7% of the total) the scar extended to the septum. 72 (49.3%) had a peritricuspid scar, and in 20 (13.7%) other areas of the RV were interested. Total low-voltage area, expressed as % of total endocardial area, was significantly higher in patients with history of PVCs [3.2% (±2.6) vs 2.2% (±1.8), p<0.05], complex PVCs at 24h-Holter ECG (Lown class ≥2) [3.4 (±2.5) vs 2.6 (±2.3), p<0.05], exercise-inducible PVCs [3.8 (±2.4) vs 2.6 (±2.2), p=0.01] and history of previous shunt [4.0 (±2.7) vs 2.6 (±2.2), p=0.01]. Scar size was also positively correlated with age (p=0.01), age at correction (p=0.01) and QRS duration on surface ECG (p<0.05). Conclusions: In patients with rCHD involving the RV it is common to observe endocardial low-voltage areas with variable distribution, not always corresponding to the sites of surgical lesion. Morover, the size of the scar tissue area correlates with some of the parameters which have been already identified as risk factors for life-threatening arrhythmias and SCD in adult patients with CHD. We suggest that EAM should become part of the routine tests for the stratification of arrhythmic risk in this population.

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Abstract 5716: Should We Treat Hyperuricemia in Adult Patients With Cyanotic Congenital Heart Disease?

Circulation ◽

10.1161/circ.118.suppl_18.s_990-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Hideshi Yamamura ◽

Kei Inai ◽

Tokuko Shinohara ◽

Hirofumi Tomimatsu ◽

Yoshiki Mori ◽

...

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Heart Disease ◽

Serum Creatinine ◽

Oxygen Saturation ◽

Congenital Heart ◽

Gouty Arthritis ◽

Cyanotic Congenital Heart Disease ◽

Adult Patients ◽

List Type

Background: Although hyperuricemia is common, it is thought that gouty arthritis is rare in adult patients (pts) with cyanotic congenital heart disease (CCHD). However, the actual frequency of hyperuricemia and gout has not been documented. Furthermore, whether hyperuricemia should be treated remains undetermined. This study investigated the incidence of hyperuricemia and gout, risk factors for hyperuricemia and gout, and whether the use of allopurinol decreases the incidence of gout in adult patients with CCHD. Methods: We studied 92 pts with CCHD, including 19 pts with Eisenmenger syndrome (mean age: 33±11 years of age, ranging from 15 to 61), M/F = 48/44) (CCHD group). Comparative data was obtained from 210 acyanotic CHD pts after biventricular repair (mean age: 31±11 years, ranging from 15 to 83, M/F = 98/112) (ACHD group). Hyperuricemia was defined as serum uric acid (UA) > 7.0mg/dl. The risk factors studied were: age, gender, RBC counts, hemoglobin, hematocrit, oxygen saturation, serum creatinine, glomerular filtration rate, cardiothoracic ratio, brain natriuretic peptide and medications, including diuretics, beta-blocker and aspirin. Results: Prevalence of hyperuricemia was 76% in the CCHD group and 24% in the ACHD group. Logistic regression analysis demonstrated that variables that significantly influence hyperuricemia were; hemoglobin over 18g/dl (odds ratio 6.2), oxygen saturation less than 90 (OR 4.8), the use of diuretics (OR 4.0), and serum creatinine higher than 1.0 mg/dl (OR 2.0). Gouty arthritis was observed in 16% in the CCHD group and only 1% in the ACHD group. The prevalence of hyperuricemia and gout in the CCHD group was significantly higher than that in the ACHD group. Of 92 pts in the CCHD group, allopurinol was administered to 37 pts for gout prophylaxis. Of 55 pts without allopurinol, 13 (24%) suffered from gout. In contrast, only 2 of 37 pts (5%) on allopurinol developed gout and the incidence was significantly lower than that in pts without allopurinol. Conclusion: These data suggest that in adult patients with CCHD, the incidence of gout is high, desaturation, polycytemia, impaired renal function, and the use of diuretics are risk factors for hyperuricemia and gout, and hyperuricemia should be treated with medication.

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Heart failure risk predictions in adult patients with congenital heart disease: a systematic review

Heart ◽

10.1136/heartjnl-2019-314977 ◽

2019 ◽

Vol 105 (21) ◽

pp. 1661-1669 ◽

Cited By ~ 7

Author(s):

Fei Wang ◽

Lee Harel-Sterling ◽

Sarah Cohen ◽

Aihua Liu ◽

James M Brophy ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Congenital Heart Disease ◽

Heart Disease ◽

Risk Prediction ◽

Congenital Heart ◽

Patient Characteristics ◽

Adverse Outcomes ◽

Adult Patients ◽

Population Characteristics

To summarise existing heart failure (HF) risk prediction models and describe the risk factors for HF-related adverse outcomes in adult patients with congenital heart disease (CHD). We performed a systematic search of MEDLINE, EMBASE and Cochrane databases from January 1996 to December 2018. Studies were eligible if they developed multivariable models for risk prediction of decompensated HF in adult patients with CHD (ACHD), death in patients with ACHD-HF or both, or if they reported corresponding predictors. A standardised form was used to extract information from selected studies. Twenty-five studies met the inclusion criteria and all studies were at moderate to high risk of bias. One study derived a model to predict the risk of a composite outcome (HF, death or arrhythmia) with a c-statistic of 0.85. Two studies applied an existing general HF model to patients with ACHD but did not report model performance. Twenty studies presented predictors of decompensated HF, and four examined patient characteristics associated with mortality (two reported predictors of both). A wide variation in population characteristics, outcome of interest and candidate risk factors was observed between studies. Although there were substantial inconsistencies regarding which patient characteristics were predictive of HF-related adverse outcomes, brain natriuretic peptide, New York Heart Association class and CHD lesion characteristics were shown to be important predictors. To date, evidence in the published literature is insufficient to accurately profile patients with ACHD. High-quality studies are required to develop a unique ACHD-HF prediction model and confirm the predictive roles of potential risk factors.

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