title: Plasma adrenomedullin relation with Doppler-derived dP/dt in patients with congestive heart failure.
abstract: BACKGROUND
  Increased circulating adrenomedullin (AM) concentration has been reported in congestive heart failure (HF) and considered as a possible marker of cardiac dysfunction.
  
  
  OBJECTIVE
  The study was undertaken to assess the relationship between circulating AM concentration and left ventricular (LV) functional state, estimated by echo-Doppler techniques in patients with mild to moderate HF and different degrees of LV dysfunction.
  
  
  METHODS
  Plasma AM, B-type natriuretic peptide (BNP), and N-terminal (NT) proBNP levels were measured in 55 patients with HF (New York Heart Association [NYHA] I n = 8, II n = 26, III n = 21) and in 20 controls; dP/dt was calculated by the Doppler tracing of the mitral regurgitation jet.
  
  
  RESULTS
  The study was completed in 51 patients. Adrenomedullin levels were higher than in controls (19.2 +/- 1.4 vs. 13.3 +/- 0.7, p < 0.005) and elevated in proportion to NYHA functional class. B-type natriuretic peptide and NT-proBNP were 344 +/- 67 vs. 12 +/- 2 pg/ml and 2196 +/- 623 vs. 52 +/- 4 pg/ml, respectively (p < 0.0001); dP/dt was better related to AM (r = 0.582, p < 0.001) than to the other peptides. Adrenomedullin was significantly (p < 0.001) different between patients grouped according to the dP/dt cut-off predictive of event-free survival.
  
  
  CONCLUSIONS
  The combination of depressed contractility and increased AM may provide a clue for further characterization of the severity of LV dysfunction in HF, independent of baseline LV ejection fraction.
authors.affiliation: Cardiology and Cardiovascular Biochemistry Laboratory, CNR Institute of Clinical Physiology, Pisa, Italy. morales@ifc.cnr.it
authors.forename: Maria-Aurora
authors.initials: MA
authors.lastname: Morales
authors.forename: Silvia
authors.initials: S
authors.lastname: Del Ry
authors.forename: Umberto
authors.initials: U
authors.lastname: Startari
authors.forename: Maristella
authors.initials: M
authors.lastname: Maltinti
authors.forename: Concetta
authors.initials: C
authors.lastname: Prontera
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
authors.forename: Daniela
authors.initials: D
authors.lastname: Giannessi
mesh_terms: D053607:Adrenomedullin; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015150:Echocardiography, Doppler / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood*; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D010455:Peptides; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin