NT-proBNP and exercise capacity in adult patients with congenital heart disease and a prosthetic valve: a multicentre PROSTAVA study.

Objectives: N-terminal B‑type natriuretic peptide (NT-proBNP) is an important biomarker for the detection of heart failure. Adults with congenital heart disease (ACHD) and a prosthetic heart valve are at risk for heart failure. This study aimed to determine the value of NT-proBNP in ACHD patients with a prosthetic valve and investigate its relationship with cardiac function and exercise capacity.
Methods: In this multi-centre cross-sectional observational study, data regarding medical history, echocardiography, exercise testing (VO ₂ peak) and laboratory blood evaluation (including NT-proBNP) were collected in ACHD patients with a single prosthetic valve (either homografts, heterografts or mechanical valves).
Results: A total of 306 ACHD patients with pulmonary valve replacement (PVR, n = 139), aortic valve replacement (n = 141), mitral valve replacement (n = 21) or tricuspid valve replacement (n = 5) were investigated. The majority of patients (77 %) were in NYHA class I or II. Elevated NT-proBNP levels (cut-off ≥125 pg/ml) were found in 50 % of the patients, with the highest levels in patients with mitral valve replacements. In this study population, NT-proBNP levels were associated with gender (p = 0.029) and VO ₂ max (p < 0.001). In PVR patients, NT-proBNP levels were associated with lower VO ₂ peak, also after adjustment for age, gender and age at valve replacement in a multivariate model (p = 0.015).
Conclusions: In patients with ACHD and a prosthetic valve, elevated NT-proBNP levels are frequently observed despite preserved NYHA class. In PVR patients, a higher NT-proBNP level was associated with a lower VO ₂ peak. These results may be of importance in the ongoing discussion about the timing of valve replacement in patients with CHD.
Competing Interests: Conflict of interestR. C. Schoonbeek, P. G. Pieper, Y. J. van Slooten, H. G. Freling, G. T. Sieswerda, A. P. J. van Dijk, M. R. M. Jongbloed, M. C. Post, B. J. Bouma, R. M. F. Berger, T. Ebels and J. P. van Melle state that they have no competing interest.