BACKGROUND: The population of adults living with congenital heart defects (ACHD) is growing. Heart failure (HF) is the leading cause of premature death in ACHD patients. There is limited information available on predictive factors of HF in ACHD patients.

OBJECTIVES: This study re-examined a group of patients with repaired or palliated congenital heart defects (CHD) initially studied in 2003, after a follow-up period of 15 years to identify and evaluate predictors of developing HF.

METHODS: All patients with repaired or palliated CHD who had participated in the initial study (n=364) were invited for a follow-up examination. Impact of maximum oxygen uptake (VO_2max) during exercise stress testing, cardiac biomarker (NT-proBNP), and QRS complex duration were investigated for developing HF during the follow-up period.

RESULTS: From 05/2017 to 04/2019 a total of 249 of the initial 364 (68%) patients participated in the follow-up study: 21% had mild, 60% had moderate, and 19% had complex CHD. NT-proBNP levels of >1.7 of the upper limit of normal, VO_2max<73% of predicted values, and QRS complex duration >120 ms were significant predictors of developing HF. All three parameters combined had the highest area-under-the-curve of 0.76, with a sensitivity of 72% and specificity of 68% for predicting developing HF.

CONCLUSIONS: The combination of NT-proBNP, VO_2max%, and QRS duration was predictive of HF development within the next 15 years in our ACHD patients. Enhanced surveillance of these parameters may be beneficial in patients with ACHD for preventative measures and early intervention.