title: Asymmetric dimethylarginine enhances cardiovascular risk prediction in patients with chronic heart failure.
abstract: OBJECTIVE
  The purpose of this study was to investigate whether elevated asymmetrical dimethylorginine (ADMA) concentrations are associated with increased cardiovascular risk in chronic heart failure (HF) patients.
  
  
  RESULTS
  253 patients with symptomatic chronic HF and impaired left ventricular function (median age 70 years, 202 males) were followed for a median of 14.2 months (interquartile range 6.8 to 21.2). ADMA and N-terminal pro-brain natriuretic peptide (NT-proBNP) were assessed by high performance liquid chromatography and by an enzyme-linked immunosorbent assay, respectively. Subjects with ADMA concentrations in the highest tertile had a significantly higher adjusted hazard ratio (HR; 2.00; 95% confidence interval [CI] 1.01 to 3.97) for occurrence of an end point (cardiac decompensation, major adverse cardiovascular events or all-cause mortality) compared with patients in the lowest tertile (P=0.046) during the first 6 months of follow-up. NT-proBNP also identified subjects at risk before adjustment for confounders at 6 and 12 months of follow-up. HR for patients with ADMA and NT-proBNP in the highest tertile was significantly increased (3.68, CI 1.67 to 8.14; at 6 months follow-up) compared with patients without ADMA and NT-proBNP in the highest tertile (P<0.001).
  
  
  CONCLUSIONS
  Elevated ADMA plasma concentrations are associated with adverse cardiovascular outcome in patients with chronic HF. Quantification of ADMA with NT-proBNP improves risk stratification in this cohort.
authors.affiliation: Department of Clinical Pharmacology, Medical University of Vienna, Austria
authors.forename: Christina
authors.initials: C
authors.lastname: Dückelmann
authors.forename: Friedrich
authors.initials: F
authors.lastname: Mittermayer
authors.forename: Dominik Georg
authors.initials: DG
authors.lastname: Haider
authors.forename: Johann
authors.initials: J
authors.lastname: Altenberger
authors.forename: Jörg
authors.initials: J
authors.lastname: Eichinger
authors.forename: Michael
authors.initials: M
authors.lastname: Wolzt
mesh_terms: D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D001317:Austria / Q000453:epidemiology; D015415:Biomarkers; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D018487:Ventricular Dysfunction, Left
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; C018524:N,N-dimethylarginine; D001120:Arginine