Heart failure guidelines classify patients into subgroups with asymptomatic versus symptomatic

ventricular dysfunction versus heart failure with a preserved ejection fraction. In

this study, this approach was applied in a series of patients with complete transposition of

the great arteries after atrial switch to assess to what extent this classification fits patients

with systemic right ventricles. The study included stable adult patients after atrial switch,

stratified according to preserved versus impaired systolic function (fractional area change

tricuspid regurgitation (TR), and normal versus elevated brain natriuretic peptide

preserved systolic function, and 20 (47.6%) had impaired systolic function; 10 patients

(23.8%) had asymptomatic right ventricular (RV) dysfunction. The latter more frequently had

patients with preserved systolic function. Normal BNP levels independently predicted preserved

RV function in all patients (odds ratio 6.4, 95% confidence interval 1.03 to 39.1, p

0.04) and in asymptomatic patients (odds ratio 14.4, 95% confidence interval 1.2 to 176.2, p

0.03). Heart failure symptoms with preserved systolic function were present in 5 patients

(11.9%), including 3 patients with significant TR. In conclusion, asymptomatic RV dysfunction

and heart failure symptoms with preserved systolic function are common in patients with

systemic right ventricles. BNP levels can be used to predict preserved systolic RV function,

especially in asymptomatic patients. Heart failure symptoms with preserved RV systolic

function can be frequently explained by the coexistence of significant TR. ©2009 Elsevier Inc.

All rights reserved. (Am J Cardiol 2009;104:414–418)