Heart failure & cardiomyopathiesResearch article
Cardiac Remodeling, Prognostic markers, and Cardiovascular Outcomes Across Heart Failure Phenotypes in Adults with Congenital Heart Disease
- Study
Authors' conclusion
In adults with CHD and HF, LVEF-defined HF phenotypes identified distinct patterns of cardiac remodeling and prognosis, with worse cardiac remodeling and adverse outcomes observed in the HFrEF phenotype. These findings support use of EF phenotype-based approach to HF management in CHD.
Study context
- Population
- Adults with congenital heart disease (CHD) and heart failure (HF), classified by left ventricular ejection fraction (LVEF)HF with Reduced EF (HFrEF) 304 (23%) · HF with Mildly Reduced EF (HFmrEF) 551 (42%) · HF with Preserved EF (HFpEF) 448 (34%)
- Participants
- 1,303 patients
- Comparison
- Cardiac function (strain imaging), prognostic markers (NT-proBNP and peak oxygen consumption), and cardiovascular outcomes (HF hospitalization and cardiovascular death/heart transplantation) compared across HFrEF, HFmrEF and HFpEF
- HFrEFn = 304
- HFmrEFn = 551
- HFpEFn = 448
Main finding
As reported in the abstract
Biatrial and right ventricular function
Graded worsening of biatrial and right ventricular function from HFpEF to HFmrEF to HFrEF
all p<0.001
Further findings
| Outcome | hazard ratio | P value |
|---|---|---|
| HF hospitalization · adjusted; highest risk with HFrEF · adjusted | 1.52 | P = 0.005 |
| Cardiovascular death/heart transplantation · adjusted; highest risk with HFrEF · adjusted | 1.74 | P = 0.002 |
NT-proBNP and peak oxygen consumption
- Despite less severe chamber dysfunction, HFpEF had higher NT-proBNP levels and lower peak oxygen consumption compared with HFmrEF
Event rates with HF therapy
- HF therapy associated with lower event rates overall; strongest association in HFrEF, more modest in HFmrEF, no significant association in HFpEF
Original publication
Cardiac Remodeling, Prognostic markers, and Cardiovascular Outcomes Across Heart Failure Phenotypes in Adults with Congenital Heart Disease. Am Heart J. Published 26 September 2026. doi:10.1016/j.ahj.2026.107618
Summarised from the published abstract; every number is checked against it