Abstract
Background: Recent studies showed that intake of long-chain n-3 polyunsaturated fatty acids reduces the incidence of cardiovascular events. Furthermore, low levels of eicosapentaenoic acid (EPA) are associated with heart failure (HF), arrhythmia, and cardiac sudden death. However, there have been few studies regarding the clinical implication of the EPA/arachidonic acid (AA) ratio in adult patients with congenital heart disease (CHD). Objectives and methods: The present study was a prospective study of 64 adult patients with CHD. We measured serum EPA and AA and divided the patients into two groups according to their EPA/AA ratio: <0.25, low group; ≥0.25, high group. Patients were observed for a mean duration of 13 months. We investigated the association between the EPA/AA ratio and clinical data and analyzed the prognostic predictive value of the EPA/AA ratio in these patients. Results: There were no significant differences between the low (n = 36) and high (n = 28) groups in age, sex, blood pressure, systemic ventricular ejection fraction, medications, or serum levels of hemoglobin A1c, creatinine, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglyceride, or B-type natriuretic peptide. A low EPA/AA ratio had significant prognostic value for arrhythmia (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.1-14.8, p = 0.03) and composite events of arrhythmia and HF hospitalization (HR 5.6, 95% CI 1.53-27.8, p < 0.01). Subgroup analysis revealed that the patients with two-ventricle circulation in the low group (n = 23) were at significantly higher risk of arrhythmia (HR 6.7, p = 0.02), HF hospitalization (HR 16.2, p < 0.01), and composite events of arrhythmia and HF hospitalization (HR 6.7, p = 0.03) than those in the high group (n = 23). In patients with single-ventricle circulation, serum EPA levels were significantly lower compared with patients with two-ventricle circulation. Conclusions: The EPA/AA ratio had a significant predictive value for cardiac events in adult patients with CHD, especially in patients with two-ventricle circulation. The effect of EPA treatment for patients with CHD should be elucidated in the future.
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