Current overview of heart failure in adults with congenital heart disease in a latin american centre
Authors: Mier Y Teran Morales E , Asseo-Benrey J , Ibarra-Jimenez N , Navarro-Martinez D A , Barrera-Real A J , Ferrer-Saldana J E , Alvarado-Ramirez M F , Angulo-Cruzado S T , Valdez-Ramos M M , Rosero-Rosero M A , Garcia-Gonzalez N E , Diaz-Gallardo L G , Garcia-Cruz E 
Published: November 2023

Abstract

Background
Congenital heart disease (CHD) affects a significant number of newborns globally. While survival rates have increased, many interventions provide only palliative therapies and not total repair, leading to chronic complications such as heart failure (HF). Treatment options for adult patients with CHD (ACHD) with HF are similar to those for HF with reduced ejection fraction (HFrEF), but there is a need for trials with hard clinical endpoints. Treatment options include cardiac resynchronization therapy, coronary revascularization, valve repair/replacement, defibrillators, and heart transplantation. More research is needed to understand the prevalence, demographic characteristics, and variables associated with ACHD-HF.

Purpose
By studying the prevalence of HF in ACHD we can better understand the long-term outcomes and health risks for this population. CHD is one of the most common birth defects, and while survival rates have improved, there is still a risk for HF and other complications as individuals age. When researching HF in this population, investigators can identify potential risk factors, develop targeted interventions, and improve health outcomes for ACHD.

Methodology
This study was piloted with a private database, filtering patients with CHD who have HF based on the ESC 2022 guides. Parameters such as the severity, left ventricle ejection fraction (LVEF), and functional class were considered. A statistical software was used to filter patients, and the resulting data was then analysed, applying the most relevant variables to the study.

Results
3539 patients, with a median age of 34 years included, 56.3% were women. Based on the ESC guidelines, patients were classified according to their CHD complexity, 1977 as mild, 642 as moderate, and 920 as severe. The most common treatment was the total repair, in 58.1% of cases, while 31.5% were in surveillance and 3.6% had no treatment. Mortality was 3.2%, 22.7% of patients lost follow-up. The most common CHD was atrial septal defect. Most patients (76.7%) were in NYHA functional class I, 18.7% in class II, 3.4% in class III, and 0.7% in class IV. LVEF was &gt;50% in 87.7% of patients, 4.7% had a LVEF between 49% and 41%, and 5.8% had LVEF &lt;40%. Bicuspid aortic valve was the most frequent CHD with reduced LVEF, in 9.8% of patients. Of the deceased, 37.5% had a LVEF &lt;40%; and severe CHD was more associated with a LVEF &lt;40%. According to the AHA patients were classified as stages B (84.5%), C (14.6%), and D (0.3%), no patients in stage A identified.

Conclusions
This study provided an overview of HF in ACHD, identifying important correlations between severity of ACHD-HF and LVEF, and the prevalence of HF among different cardiopathies. The overall mortality of this review was scarce, and of these patients, one-third had previous history of reduced LVEF. HF associated with ACHD is becoming increasingly common in cardiology practice; thus, further studies regarding its prevalence need to be done.