Cardiology ·
GDMT associated with better outcomes in cc-TGA with severe RV dysfunction
In a study of 213 adults with congenitally corrected transposition of the great arteries (cc-TGA), greater use and uptitration of guideline-directed medical therapy (GDMT) were associated with improved measures of systemic right ventricular function and lower mortality. Associations with clinical benefit were observed in patients with moderate or severe, but not mild, RV systolic dysfunction.
- 213 adults with cc-TGA were assessed at baseline and one year.
- Higher GDMT scores were associated with improved RV function and NT-proBNP.
- Associations with benefit were limited to moderate or severe RV dysfunction.
- The observational findings do not establish causality.
Researchers assessed GDMT use, systemic right ventricular free wall strain (RVFWS), and NT-proBNP at baseline and one-year follow-up in 213 adults with cc-TGA and systemic RV systolic dysfunction. Participants had a mean age of 43 years, and 54% were male. The study evaluated changes in RVFWS and NT-proBNP, as well as mortality and a composite of heart-failure hospitalization, death, and heart transplantation.
At baseline, mean GDMT score was 1.97, increasing by a mean of 0.74 points at one year. A quarter of patients had improved RV systolic function, and 56% had improved neurohormonal activation, defined as a relative NT-proBNP reduction greater than 20%. During follow-up, 34 patients (16%) died. Higher baseline GDMT scores and greater score increases were associated with improvements in both measures and lower risks of mortality and the composite endpoint.
Associations with clinical benefit were seen only in patients with moderate or severe RV systolic dysfunction, not mild dysfunction. The findings are observational and do not establish that GDMT caused the improvements or specify which therapies drove the associations.
In practice
For adults with cc-TGA and systemic RV systolic dysfunction, this study found that higher GDMT use and increases in GDMT score over one year were associated with improved RV strain and NT-proBNP, as well as lower mortality and risk of a composite adverse outcome. Associations with benefit were reported in moderate or severe, but not mild, RV dysfunction. Because the evidence is observational, it does not show that GDMT caused these outcomes or identify which therapies accounted for the associations; it does not by itself establish a treatment change.
AI-generated clinical interpretation · Not editor-reviewed
Is this summary clinically accurate?
Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.
Sign in to rate this summary →Source
European Heart Journal: Heart failure therapy in congenitally corrected transposition of the great arteries: effect on right ventricular function and survival ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.