title: Comparison of plasma levels of mature adrenomedullin and natriuretic peptide as markers of cardiac function in hemodialysis patients with coronary artery disease.
abstract: BACKGROUND
  It has been suggested that, like ANP and BNP, high plasma levels of mature adrenomedullin (mAM) indirectly reflect the severity of heart failure or renal failure. However, the relationship between mAM levels and hemodynamics and cardiac function has not been examined in hemodialysis (HD) patients with coronary artery disease (CAD). The best marker, among mAM, ANP and BNP, for left-ventricular function in those patients is also unclear.
  
  
  METHODS
  Plasma levels of mAM, total AM (tAM), ANP and BNP were determined before HD in chronic HD patients with CAD (group 1; n = 17) and were compared with those of HD patients without cardiac disease (group 2; n = 22). We examined their relationship to hemodynamics and cardiac function in group 1 using data obtained by cardiac catheterization.
  
  
  RESULTS
  Plasma levels of ANP and BNP were significantly higher in group 1 than in group 2, but there was no significant difference in plasma levels of mAM and tAM between the two patient groups. Plasma levels of both mAM and tAM significantly correlated with right atrial pressure (RAP), and only plasma tAM levels correlated with pulmonary artery pressure (PAP) and pulmonary artery wedge pressure (PAWP). However, no correlations were found between levels of the two forms of AM and ejection fraction (EF). In contrast, plasma ANP and BNP levels significantly correlated with both PAP and PAWP, and also with EF, although they did not correlate with RAP. The correlation of PAP and PAWP with ANP and BNP levels was closer than that with tAM levels. The most significant correlation was between BNP levels and EF (r = -0.756, p < 0.0001).
  
  
  CONCLUSIONS
  Our results suggest that the mAM level may be less useful than natriuretic peptide levels as a marker of cardiac function in HD patients with CAD, and that the BNP level might be the best indicator of left-ventricular function. In addition, cardiac disease such as CAD may have a minor impact on mAM levels compared to renal failure.
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Yahatanishi-ku, Kitakyushu, Japan. mdosa@clnc.uoeh-u.ac.jp
authors.forename: Akihiko
authors.initials: A
authors.lastname: Osajima
authors.forename: Masahiro
authors.initials: M
authors.lastname: Okazaki
authors.forename: Masahito
authors.initials: M
authors.lastname: Tamura
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Anai
authors.forename: Narutoshi
authors.initials: N
authors.lastname: Kabashima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Suda
authors.forename: Masako
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ota
authors.forename: Yuujiro
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Kaori
authors.initials: K
authors.lastname: Kanegae
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Nakashima
mesh_terms: D053607:Adrenomedullin; D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000097:blood / Q000503:physiopathology*; D005260:Female; D006321:Heart / Q000502:physiology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010455:Peptides / Q000378:metabolism*; D012044:Regression Analysis; D006435:Renal Dialysis
chemical_list: D015415:Biomarkers; D010455:Peptides; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor