Bioelectrical impedance analysis in the management of heart failure 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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Causes of death in a contemporary adult congenital heart disease cohort

Heart ◽

10.1136/heartjnl-2017-312777 ◽

2018 ◽

Vol 104 (20) ◽

pp. 1678-1682 ◽

Cited By ~ 25

Author(s):

Christopher Yu ◽

Benjamin M Moore ◽

Irina Kotchetkova ◽

Rachael L Cordina ◽

David S Celermajer

Keyword(s):

Heart Failure ◽

Congenital Heart Disease ◽

Heart Disease ◽

Cause Of Death ◽

Congenital Heart ◽

Causes Of Death ◽

Adult Congenital Heart Disease ◽

Premature Death ◽

Adult Patients ◽

Age Of Death

ObjectiveThe life expectancy of patients with congenital heart disease (CHD) has significantly improved with advances in their paediatric medical care. Mortality patterns are changing as a result. Our study aims to describe survival and causes of death in a contemporary cohort of adult patients with CHD.MethodsWe reviewed 3068 patients in our adult CHD database (age ≥16 years, seen at least once in our centre between 2000 and 2015), and documented the number and causes of death, via Australia’s National Death Index. Survival and mortality patterns were analysed by complexity of CHD and by underlying congenital diagnosis.ResultsOur cohort comprised 3068 adult patients (53% male). The distribution of patients (per the Bethesda classification) was 47% simple, 34% moderate and 18% complex (1% not classifiable). Over a median follow-up of 6.2 years (IQR 3.5–10.4), 341 patients (11%) died with an incidence of 0.4 deaths/100 patient years (py). Survival was significantly worse with increasing complexity of CHD (p<0.001); mortality rate in the simple group was 0.3 deaths/100 py with a median age of death 70 years, and in the complex group was 1.0 death/100 py with a median age of death 34 years. Overall, non-cardiac causes of death outnumbered cardiac causes, at 54% and 46%, respectively. The leading single cause of death was heart failure (17%), followed by malignancy (13%). Simple adult CHD patients mostly died due to non-cardiac causes such as malignancy. Perioperative mortality only accounted for 5% of deaths.ConclusionsPremature death is common in adults with CHD. Although heart failure remains the most common cause of death, in the contemporary era in a specialist CHD centre, non-cardiac related deaths outnumber cardiac deaths, particularly in those with simple CHD lesions.

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Acute Heart Failure in Adult Patients with Congenital Heart Disease

Heart Failure in Adult Congenital Heart Disease - Congenital Heart Disease in Adolescents and Adults ◽

10.1007/978-3-319-77803-7_9 ◽

2018 ◽

pp. 143-161

Author(s):

Alexander Van De Bruaene ◽

S. Lucy Roche

Keyword(s):

Heart Failure ◽

Congenital Heart Disease ◽

Heart Disease ◽

Acute Heart Failure ◽

Congenital Heart ◽

Adult Patients

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Body composition, appetite-related hormones, adipocytokines, and heart failure in adult patients with congenital heart disease: A preliminary study

Congenital Heart Disease ◽

10.1111/chd.12555 ◽

2017 ◽

Vol 13 (1) ◽

pp. 79-84 ◽

Cited By ~ 8

Author(s):

Yumi Shiina ◽

Tomoaki Murakami ◽

Noriko Matsumoto ◽

Daisuke Okamura ◽

Yuta Takahashi ◽

...

Keyword(s):

Heart Failure ◽

Congenital Heart Disease ◽

Body Composition ◽

Heart Disease ◽

Congenital Heart ◽

Adult Patients ◽

Preliminary Study

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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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