Original Article Association between N-terminal pro-brain natriuretic peptide and quality of life in adult patients with congenital heart disease John O. Younge, 1,2 Jannet A. Eindhoven, 1 Elisabeth W. M. J. Utens, 3 Petra Opić, 1 Judith A. A. E. Cuypers, 1 Annemien E. van den Bosch, 1 Maarten Witsenburg, 1 Ron T. van Domburg, 1 M. G. Myriam Hunink, 2 Jolien W. Roos-Hesselink 1 1 Department of Cardiology; 2 Department of Clinical Epidemiology; 3 Department of Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands Abstract Aims: Advances in medical treatment have resulted in increased life expectancy in congenital heart disease. Consequently, the focus of management has shifted from reducing mortality to reducing long-term morbidity with the goal of improving quality of life. A predictor of quality of life might be N-terminal pro-brain natriuretic peptide, a well-established marker for heart failure. We aimed to determine the association between N-terminal pro-brain natriuretic peptide and quality of life in patients with congenital heart disease. Methods: We collected blood samples from consecutive patients who were initially operated between 1968 and 1980 (47.8% women; mean age 40.2 ± 5.4 years). The 36-item Short-Form Health Survey was completed to assess subjective health status as a measure of quality of life. Analysis was performed for the entire group and for subgroups defined as simple versus complex congenital heart diseases. Median N-terminal pro-brain natriuretic peptide level was 15.2 pmol/L (overall range 1.3–299.3 pmol/L). N-terminal pro-brain natriuretic peptide levels were associated with the subdomain physical functioning (β = -0.074, p = 0.031). This association remained significant after adjustment for age and sex (β = -0.071, p = 0.038) and after adjustment for age, sex, body mass index, left ventricular function, and renal function (β = -0.069, p = 0.048). In complex congenital heart disease, the association between N-terminal pro-brain natriuretic peptide and physical functioning remained significant in multivariable analysis (β = -0.076, p = 0.046). No associations were found in the simple con- genital heart disease group or on the other health status subdomains. Conclusion: In adults operated for congenital heart disease, N-terminal pro-brain natriuretic peptide is associated with the subdomain physical, primarily in the complex subgroup. Keywords: Congenital heart disease; quality of life; natriuretic peptides Received: 26 June 2013; Accepted: 20 October 2013; First published online: 21 November 2013 T HE MANY ADVANCES IN THE MEDICAL CARE OF patients with congenital heart disease in the past few decades have resulted in an increased survival. Owing to this, the prevalence of adults living with congenital heart disease is increasing. This population is estimated to increase by 5% per year and currently consists of more adults than children. 1 The focus of attention has shifted from pure survival to long-term morbidity (sequela), quality of life, and their determinants. Several studies have reported on the short- and long-term outcome of quality of life in congenital heart disease patients. Although some studies repor- ted impairments of specific quality of life scales, other studies indicated that overall quality of life was comparable to that seen in the general population. 2,3 Correspondence to: J. W. Roos-Hesselink, Department of Cardiology, Ba-583, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. Tel: + 31(0)10 7032432; Fax: + 31(0)10 7035498; E-mail: j.roos@erasmusmc.nl Cardiology in the Young (2015), 25, 288–294 © Cambridge University Press, 2013 doi:10.1017/S1047951113002114