title: Impact of asymmetric dimethylarginine on mortality after acute myocardial infarction.
abstract: OBJECTIVE
  Asymmetrical dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide (NO) synthases. From a prospective cohort of patients with acute myocardial infarction (MI), we aimed to analyze the predictive value of circulating ADMA concentrations on prognosis.
  
  
  RESULTS
  Blood samples from 249 consecutive patients hospitalized for acute MI <24 hours were taken on admission. Serum levels of ADMA and its stereoisomer, symmetrical dimethylarginine (SDMA), were determined using high-performance liquid chromatography. The independent predictors of ADMA were glomerular filtration rate, female sex, and SDMA (R(2)=0. 25). Baseline ADMA levels were higher in patients who had died than in patients who were alive at 1 year follow-up (1.23 [0.98 to 1.56] versus 0.95 [0.77 to 1.20] micromol/L, P<0.001). By Cox multivariate analysis, the higher tertile of ADMA (median [interquartile range]: 1.45 [1.24 to 1.70] micromol/L) was a predictor for mortality (Hazard Ratio [95% CI], 4.83 [1.59 to 14.71]), when compared to lower tertiles, even when adjusted for potential confounders, such as acute therapy, biological, and clinical factors.
  
  
  CONCLUSIONS
  Our study suggests that the baseline ADMA level has a strong prognostic value for mortality after MI, beyond traditional risk factors and biomarkers.
authors.affiliation: Laboratory of Experimental Cardiovascular Pathophysiology and Pharmacology, Faculty of Medicine, University of Burgundy, Dijon Cedex, France. marianne.zeller@u-bourgogne.fr
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
authors.forename: Claudia
authors.initials: C
authors.lastname: Korandji
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Guilland
authors.forename: Pierre
authors.initials: P
authors.lastname: Sicard
authors.forename: Catherine
authors.initials: C
authors.lastname: Vergely
authors.forename: Luc
authors.initials: L
authors.lastname: Lorgis
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Beer
authors.forename: Laurence
authors.initials: L
authors.lastname: Duvillard
authors.forename: Anne-Cécile
authors.initials: AC
authors.lastname: Lagrost
authors.forename: Daniel
authors.initials: D
authors.lastname: Moreau
authors.forename: Philippe
authors.initials: P
authors.lastname: Gambert
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.forename: Luc
authors.initials: L
authors.lastname: Rochette
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D015415:Biomarkers; C024917:symmetric dimethylarginine; C018524:N,N-dimethylarginine; D001120:Arginine