Predictors of adverse cardiovascular event in patients with a systemic RV: A prospective cohort study

Background In complete transposition of the great arteries (TGA) palliated by atrial switch operation, systemic right ventricle (sRV) failure and rhythm disturbances compromise survival. We aimed to determine predictive factors of severe cardiovascular events in this population. Methods Forty-eight adult patients with TGA palliated (36 males, median age = 32 years, IQR [23–35]) were prospectively enrolled from 2011 to 2012. At baseline, all subjects underwent a clinical examination with ECG and exercise test, an echocardiography, a cardiac magnetic resonance imaging (cMRI) assessment and biomarkers measurements. Main adverse cardiac events (MACE) were defined by hospitalization for heart failure, arrhythmia, heart transplantation and death. Results At baseline, most of patients were asymptomatic (85% NYHA1, median predictive VO2 = 66% IQR [58–73]), with a relatively good sRV function (cMRI sRVEF = 52% IQR [44-58]), and tricuspid regurgitation grade was mild in 87%. Baseline concentration of BNP was 34 pg/ml (IQR [14-54]) but higher than in controls (P  Fig. 1 ). Conclusion Patients with a TGA palliated by atrial switch are at high risk of severe cardiovascular events. Increase in NYHA functional class and BNP concentration must be regularly controlled to detect patients at risk.