title: Evaluation of neurohumoral activation (adrenomedullin, BNP, catecholamines, etc.) in patients with acute myocardial infarction.
abstract: OBJECTIVE
  The object of our study was to identify the most useful predictor of patient prognosis in acute myocardial infarction (AMI), from 7 acute-phase cardiovascular peptides which take part in neurohumoral activation [brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), renin, aldosterone, adrenomedullin, epinephrine and norepinephrine].
  
  
  METHODS
  In 141 consecutive AMI patients, 24 hours from onset, we evaluated plasma concentration levels of the 7 types of cardiovascular peptides and the relationships between the values of these peptides and short-term clinical prognosis, including mortality.
  
  
  RESULTS
  Plasma levels of all cardiovascular peptides were significantly higher in patients who suffered mortality than in surviving patients (BNP: 1,267+/-997 pg/ml vs. 293+/-327 pg/ml, p<0.0001; ANP: 164+/-186 pg/ml vs. 64+/-76 pg/ml, p<0.001; adrenomedullin: 13.61+/-3.29 Fmol/l vs. 3.45+/-1.52 Fmol/I, p<0.0001; renin: 8.79+/-7.15 ng/ml/h vs. 4.34+/-5.10 ng/ml/h, p<0.01; aldosterone: 249+/-210 pg/ml vs. 68+/-74 pg/ml, p<0.0001; epinephrine: 3,191+/-8,360 pg/ml vs. 68+/-74 pg/ml, p<0.0001; norepinephrine: 21.8+/-46.2 ng/ml vs. 0.9+/-0.8, ng/ml p<0.0001). Multivariate analysis identified only high levels of adrenomedullin as an independent related factor of cardiogenic shock (risk ratio: 5.84, 95% C.I.: 1.80-18.95, p=0.003), and as an independent predictor of short-term mortality (risk ratio: 16.16, 95% C.I.: 1.38-189.71, p=0.03).
  
  
  CONCLUSIONS
  Acute-phase neurohumoral activation, involving renin, aldosterone, epinephrine, norepinephrine, BNP, ANP, and adrenomedullin may be closely related to poor patient outcomes, including mortality. Our results suggest that acute-phase plasma adrenomedullin concentrations may be the most useful predictor of patient prognosis in the setting of AMI, out of the 7 types of cardiovascular peptides involved in neurohumoral activation.
authors.affiliation: Department of Cardiovascular Medicine and Course of Medical and Dental Science, Graduate School of Biomedical Science, Nagasaki University, Nagasaki.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Katayama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakashima
authors.forename: Shinnosuke
authors.initials: S
authors.lastname: Furudono
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Honda
authors.forename: Shin
authors.initials: S
authors.lastname: Suzuki
authors.forename: Katsusuke
authors.initials: K
authors.lastname: Yano
mesh_terms: D053607:Adrenomedullin; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002395:Catecholamines / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010455:Peptides / Q000097:blood*; D011379:Prognosis; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D002395:Catecholamines; D010455:Peptides; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin