Heart and Vessels

, Volume 32, Issue 12, pp 1513–1522 | Cite as

Clinical implications of eicosapentaenoic acid/arachidonic acid ratio (EPA/AA) in adult patients with congenital heart disease

  • Miki Kanoh
  • Kei InaiEmail author
  • Tokuko Shinohara
  • Hirofumi Tomimatsu
  • Toshio Nakanishi
Original Article


Recent studies showed that a low ratio between the levels of eicosapentaenoic acid and those of arachidonic acid (EPA/AA) is associated with higher incidence of coronary artery disease and poor prognosis of heart failure, arrhythmia, and cardiac sudden death. However, the clinical implications of EPA/AA in adult patients with congenital heart disease remain unclear. We aimed to assess the prognostic value of EPA/AA regarding cardiac events in adult patients with congenital heart disease. We measured the serum levels of eicosapentaenoic acid and arachidonic acid in 130 adult patients (median age, 31 years) stratified into two groups according to their EPA/AA (low, ≤0.22; high, >0.22). We prospectively analyzed the association between EPA/AA and incidence of cardiac events during a mean observation period of 15 months, expressed in terms of hazard ratio (HR) with 95% confidence interval (95% CI). In the subgroup of patients with biventricular circulation (2VC) (n = 76), we analyzed the same clinical endpoints. In our study population, EPA/AA was not associated with the incidence of arrhythmic events (HR, 1.52; 95% CI, 0.82–2.85; p = 0.19), but low EPA/AA was a predictor of heart failure hospitalization (HR, 2.83; 95% CI, 1.35–6.30; p < 0.01). Among patients with 2VC, an EPA/AA of ≤0.25 was associated with a significantly higher risk of arrhythmic events (HR, 2.55; 95% CI, 1.11–6.41; p = 0.03) and heart failure hospitalization (HR, 5.20; 95% CI, 1.78–18.1; p < 0.01). EPA/AA represents a useful predictor of cardiac events in adult patients with congenital heart disease.


Eicosapentaenoic acid/arachidonic acid ratio (EPA/AA) Adult congenital heart disease n-3 polyunsaturated fatty acid (PUFA) Heart failure Arrhythmia 



We would like to thank Editage ( for English language editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent was not required.

Submission declaration and verification

The results of this study were presented at the American Heart Association (AHA) 2015 Scientific Sessions, Orlando, FL, USA, November 7–11, 2015.


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Copyright information

© Springer Japan KK 2017

Authors and Affiliations

  • Miki Kanoh
    • 1
  • Kei Inai
    • 1
    Email author
  • Tokuko Shinohara
    • 1
  • Hirofumi Tomimatsu
    • 1
  • Toshio Nakanishi
    • 1
  1. 1.Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care, Department of Pediatric CardiologyTokyo Women’s Medical UniversityTokyoJapan

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