Abstract 9638: Abnormal Glucose Metabolism Predicts Morbidity and Mortality in Adult Patients With Complex Congenital Heart Disease

Abstract

Background: Adult patients with complex congenital heart disease (ACHD) have a high prevalence of abnormal glucose metabolism (AGM). However, the impact of AGM on their prognosis remains unclear. Purpose: This study was to clarify the prognostic value of AGM assessed by 75g oral glucose tolerance test (OGTT) in ACHD. Method and Results: We performed a 75g OGTT to detect AGM in 414 consecutive ACHD (27 ± 8 years), including 36 unrepaired patients (Cy), 135 Fontan patients, 243 post-biventricular patients, and 27 healthy controls (27 ± 5 years), and compared the results with the hemodynamics, neurohumoral activities, peak oxygen uptake, unscheduled hospitalization (USH), and all cause mortality. When compared with the control group, fasting blood glucose level (FBS) was lower, especially the group Cy, and postprandial hyperglycemia measured by area under the curve of glucose (BS-AUC) was higher in all ACHD groups (p < 0.0001 for all). The lower body mass index (BMI) and hypoxia independently determined the FBS, while older age, greater BMI, high plasma renin activity and central venous pressure independently determined the high BS-AUC (p < 0.05-0.01). Greater BS-AUC (per 1 g/dl, HR:1.07, 95%CI:1.01-1.13, p = 0.02) and lower FBS (per 1 mg/dl, HR:0.89, 95%CI:0.83-0.96, p = 0.002) predicted USH and mortality, respectively. Conclusions: Body composition and heart failure severity are closely associated with AGM in ACHD and the AGM predicts the morbidity and mortality, implying an importance of glucose metabolic management for the better long-term outcome in ACHD.