Predicting Outcome in Adult Patients With Congenital Heart Disease: A Systematic Review and Meta-Analysis on the Predictive Value of NT-proBNP and High-Sensitive Troponin T.

Abstract

Objective: This study is aimed at evaluating the predictive value of high-sensitive cardiac troponin T (hs-TnT), and N-terminal probrain natriuretic peptide (NT-proBNP), for cardiovascular events and/or survival in stable adult congenital heart disease (ACHD) patients. Methods: A systematic review along with a meta-analysis was done on studies from 2014 to 2024 that examined hs-TnT, NT-proBNP, and their association with cardiac events and/or mortality in adult patients with congenital heart disease. A comprehensive search was conducted across major databases, and studies reporting biomarker levels and relevant outcomes were included. Data on study characteristics and hazard ratios (HRs) were extracted, and pooled estimates were calculated using random-effects meta-analysis, with heterogeneity assessed through the I ² statistic. STATA software was used for data analysis. Results: A total of five studies, consisting of 1294 adult congenital heart disease (ACHD) patients, were included in this meta-analysis. Elevated NT-proBNP levels were significantly associated with an increased risk of mortality or cardiac events (HR: 2.13; 95% CI: 1.84-2.42), which remained significant after adjustment for confounding factors (adjusted HR: 2.34; 95% CI: 1.55-3.13). Elevated hs-TnT levels were also associated with a higher risk of adverse outcomes (HR: 1.57; 95% CI: 1.36-1.78), with the association remaining significant after adjustment (adjusted HR: 2.65; 95% CI: 1.22-5.76). Sensitivity analysis excluding a study with a lower hs-TnT cut-off further strengthened the association (adjusted HR: 3.03; 95% CI: 0.86-5.21) and reduced heterogeneity. Conclusion: In conclusion, this meta-analysis shows the prognostic value of both NT-proBNP and hs-TnT in adults with congenital heart disease. Each of these markers offered a distinct but complementary clinical insight. Although methodological differences of the included studies limit direct comparison, our systematic review supports the potential value of incorporating both biomarkers into routine risk assessment.