title: Increase in plasma adrenomedullin in patients with heart failure characterised by diastolic dysfunction.
abstract: OBJECTIVE
  To investigate the relation between plasma adrenomedullin and the severity of diastolic dysfunction in patients with heart failure.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  77 patients (mean (SEM) age 66.3 (1.2) years; 75% male) who were being followed in the outpatient clinic after admission to hospital for acute heart failure.
  
  
  METHODS
  Same day echocardiography with Doppler studies; determination of venous adrenomedullin concentration by radioimmunoassay.
  
  
  METHODS
  Plasma adrenomedullin concentration and its correlation with systolic and diastolic function.
  
  
  RESULTS
  31 patients (40%) had isolated diastolic dysfunction (ejection fraction > 50%), and the remaining 46 had a depressed ejection fraction (< 50%). Of the patients with diastolic dysfunction, 17 had a restrictive filling pattern. In all but one of these there was coexisting systolic failure (chi(2) = 10.7, p = 0.001). Patients with systolic heart failure and a restrictive filling pattern (group 1, n = 16) had a higher plasma adrenomedullin than those with systolic failure and a non-restrictive filling pattern (group 2, n = 30) or with isolated diastolic heart failure and a non-restrictive filling pattern (group 3, n = 30) (mean (SEM): 91.7 (21.1) v 38.4 (8.8) v 34.0 (6.5) pmol/l, both p < 0.05). All heart failure values were higher (p < 0.01) than the control value (6.9 (1.2) pmol/l). Ejection fraction and left ventricular dimensions were similar in groups 1 and 2. Plasma adrenomedullin did not correlate with ejection fraction or New York Heart Association functional class. Stepwise multiple regression analysis showed that the presence of a restrictive filling pattern was the only independent variable associated with a high plasma adrenomedullin.
  
  
  CONCLUSIONS
  Plasma adrenomedullin concentrations in patients with heart failure are determined by the presence of diastolic dysfunction, and are especially raised in the presence of a restrictive filling pattern. There appears to be no correlation with systolic dysfunction.
authors.affiliation: Department of Medicine, Queen Mary Hospital and the Institute of Cardiovascular Science and Medicine, University of Hong Kong, Pokfulam Road, Hong Kong. cmyua@hkucc.hku.hk
authors.forename: C M
authors.initials: CM
authors.lastname: Yu
authors.forename: B M
authors.initials: BM
authors.lastname: Cheung
authors.forename: R
authors.initials: R
authors.lastname: Leung
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.forename: W H
authors.initials: WH
authors.lastname: Lai
authors.forename: C P
authors.initials: CP
authors.lastname: Lau
mesh_terms: D000208:Acute Disease; D053607:Adrenomedullin; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002303:Cardiac Output, Low / Q000097:blood* / Q000000981:diagnostic imaging; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D010455:Peptides / Q000097:blood*; D011446:Prospective Studies; D011863:Radioimmunoassay; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000097:blood*
chemical_list: D015415:Biomarkers; D010455:Peptides; D053607:Adrenomedullin