title: A 6-year follow-up study of adult patients with congenitally corrected transposition.
abstract: The aims of this study were to assess the development of heart failure in patients with congenitally corrected transposition of the great arteries in a medium-term follow-up, to identify the impact of tricuspid regurgitation on the development of heart failure, and to determine the most reliable marker for its identification. The prospective 6-year follow-up study included 19 adult patients. All patients were evaluated clinically by the determination of N-terminal pro-hormone brain natriuretic peptide levels, exercise stress testing, echocardiography magnetic resonance, or CT. Among them, two patients died of heart failure. There was a decline in exercise capacity and systolic systemic ventricular function (p=0.011). Systemic ventricular ejection fraction decreased (48.3±13.7 versus 42.7±12.7%, p=0.001). Tissue Doppler imaging showed a decline in peak tricuspid systolic annular velocity (10.3±2.0 versus 8.3±2.5 cm/second, p=0.032) and peak tricuspid early diastolic annular velocity (14.6±4.3 versus 12.0±4.5 cm/second, p=0.048). The tricuspid regurgitation did not increase significantly. N-terminal pro-hormone brain natriuretic peptide levels increased (127.0 ng/L(82.3-305.8) versus 226.0 ng/L(112.5-753.0), p=0.022). Progressive exercise intolerance in congenitally corrected transposition of the great arteries appears to be driven mainly by a progression in systemic right ventricular dysfunction. Tricuspid regurgitation is likely to play a role, especially in patients with structural abnormalities of the tricuspid valve - Ebstein anomaly. The N-terminal pro-hormone brain natriuretic peptide levels and tissue Doppler parameters appear sensitive in detecting changes over time and may guide management.
authors.affiliation: 1Department of Cardiology,University Medical Centre Ljubljana,Zaloška 7,1525 Ljubljana,Slovenia.
authors.forename: Mirta
authors.initials: M
authors.lastname: Koželj
authors.affiliation: 1Department of Cardiology,University Medical Centre Ljubljana,Zaloška 7,1525 Ljubljana,Slovenia.
authors.forename: Marta
authors.initials: M
authors.lastname: Cvijić
authors.affiliation: 2Institute of Radiology,University Medical Centre Ljubljana,Zaloška 7,1525 Ljubljana,Slovenia.
authors.forename: Pavel
authors.initials: P
authors.lastname: Berden
authors.affiliation: 3Department of Paediatrics,University Medical Centre Ljubljana,Zaloška 7,1525 Ljubljana,Slovenia.
authors.forename: Tomaž
authors.initials: T
authors.lastname: Podnar
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013318:Stroke Volume; D013599:Systole; D014057:Tomography, X-Ray Computed; D014188:Transposition of Great Vessels / Q000175:diagnosis* / Q000235:genetics*; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*; D016278:Ventricular Function, Right; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Congenitally corrected transposition; adults; follow-up; heart failure