Abstract 84 Prediabetes predicts supraventricular tachycardia in adult congenital heart disease - independent of disease complexity and NT-proBNP elevation

Background

The increasing life expectancy in adults with congenital heart defects (ACHD) leads to a growing significance of non-cardiac comorbidities potentially modulating morbidity and mortality. In acquired heart disease, diabetes mellitus (DM) is associated with an increased risk of arrhythmias. The role of dysglycemia in ACHD is less clear. Supraventricular tachycardias (SVT) belong to the most relevant complications in ACHD. This study examined the role of prediabetes on future SVT (intra-atrial re-entry-tachycardia and atrial fibrillation).

Methods

This retrospective cross-sectional study included 636 patients with ACHD (mean age 35.1±11.1 years, 55.3% male, disease complexity: great 54.2%, moderate 31.9%, mild 13.7%). Mean follow-up was 41.7±12.7 months. A small number of patients with DM (n=8) were excluded. We evaluated the impact of prediabetes (HBA1c 5.7-6.4%) on future SVT. Cox proportional survival analysis estimated the impact of prediabetes on outcome.

Results

Prediabetes was present in seventy-nine individuals (12.4%). Fifty-two patients (8.2%) experienced SVT. In raw data univariate analysis significant predictors of future SVT (p<0.05 for all) were prediabetes, heart disease complexity, oxygen saturation, high density lipoprotein, NT-proBNP levels, previous SVT and previous cardiac repair. In multivariate Cox proportional survival analysis even after adjustment for age, sex and BMI prediabetes (p=0.005), disease complexity (p=0.003) and NT-proBNP elevation (p<0.001) remained as single predictors. Adjustment for previous arrhythmias identified prediabetes (HR 2.32; 95% CI 1.13-4.76; p=0.022), disease complexity (HR 2.37; 95% CI 1.15-4.86; p=0.019) and NT-proBNP elevation (HR 1.00; 95% CI 1.00-1.00; p<0.001) as independent predictors of future SVT.

Conclusion

In ACHD already prediabetes appears to be associated with the occurrence of long-term complications such as SVT. Assessment of glycemic state should be integrated in long-term care. Dysglycemia represents a modifiable risk factor, future studies are needed to determine whether life-style modification and medical treatment might play a role in arrhythmia prevention.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Prediabetes predicts supraventricular tachycardia in adult congenital heart disease - independent of disease complexity and NT-proBNP elevation
C. Hüsch¹, J. F. Kluge¹, L. H. Lemke¹, S. Hohmann¹, D. Duncker¹, J. Bauersachs¹, M. Westhoff-Bleck¹
¹Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover;
Background The increasing life expectancy in adults with congenital heart defects (ACHD) leads to a growing significance of non-cardiac comorbidities potentially modulating morbidity and mortality. In acquired heart disease, diabetes mellitus (DM) is associated with an increased risk of arrhythmias. The role of dysglycemia in ACHD is less clear. Supraventricular tachycardias (SVT) belong to the most relevant complications in ACHD. This study examined the role of prediabetes on future SVT (intra-atrial re-entry-tachycardia and atrial fibrillation). Methods This retrospective cross-sectional study included 636 patients with ACHD (mean age 35.1±11.1 years, 55.3% male, disease complexity: great 54.2%, moderate 31.9%, mild 13.7%). Mean follow-up was 41.7±12.7 months. A small number of patients with DM (n=8) were excluded. We evaluated the impact of prediabetes (HBA1c 5.7-6.4%) on future SVT. Cox proportional survival analysis estimated the impact of prediabetes on outcome. Results Prediabetes was present in seventy-nine individuals (12.4%). Fifty-two patients (8.2%) experienced SVT. In raw data univariate analysis significant predictors of future SVT (p<0.05 for all) were prediabetes, heart disease complexity, oxygen saturation, high density lipoprotein, NT-proBNP levels, previous SVT and previous cardiac repair. In multivariate Cox proportional survival analysis even after adjustment for age, sex and BMI prediabetes (p=0.005), disease complexity (p=0.003) and NT-proBNP elevation (p<0.001) remained as single predictors. Adjustment for previous arrhythmias identified prediabetes (HR 2.32; 95% CI 1.13-4.76; p=0.022), disease complexity (HR 2.37; 95% CI 1.15-4.86; p=0.019) and NT-proBNP elevation (HR 1.00; 95% CI 1.00-1.00; p<0.001) as independent predictors of future SVT. Conclusion In ACHD already prediabetes appears to be associated with the occurrence of long-term complications such as SVT. Assessment of glycemic state should be integrated in long-term care. Dysglycemia represents a modifiable risk factor, future studies are needed to determine whether life-style modification and medical treatment might play a role in arrhythmia prevention.
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