Prognostic Value of N-Terminal Pro–B-Type Natriuretic Peptide for Risk Stratification in Adults With Fontan Palliation

Background: There are limited data about the prognostic role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in adults with Fontan palliation. The purpose of this study was to determine the correlates and the prognostic value of serial NT-proBNP assay for risk stratification in adults with Fontan palliation. Methods: This is a retrospective cohort study of adults with Fontan palliation who had ≥1 NT-proBNP measurement in the outpatient clinic (2003-2023). In patients with ≥3 NT-proBNP measurements, serial NT-proBNP was calculated as the mean of the first 3 measurements. The study outcome was death/transplant. Results: Of 369 patients (age 27 ± 8 years; 55% male) with NT-proBNP, 214 (58%) had serial measurements. The baseline level was 217 (82, 562) pg/mL, whereas the serial value was 261 (98, 715) pg/mL. The correlates of higher NT-proBNP levels were older age, atriopulmonary connection, atrial fibrillation, hepatorenal dysfunction, systemic ventricular dilation and systolic dysfunction, and higher Fontan pressures and pulmonary artery wedge pressure. Baseline and serial NT-proBNP levels were associated with death/transplant independent of anatomic indices, comorbidities, and hemodynamic indices. Serial NT-proBNP levels had superior prognostic value to single (baseline) NT-proBNP measurements, echocardiographic indices, cardiac magnetic resonance imaging indices, and cardiac catheterization indices. Conclusions: These findings have important clinical implications in the management of adults with Fontan palliation because NT-proBNP assay is inexpensive, readily available, and noninvasive, and hence ideal for longitudinal assessment. Further studies are required to determine whether NT-proBNP can be used as a surrogate marker to monitor response to therapeutic interventions in this population.