title: The midregional portion of proadrenomedullin is an independent predictor of left ventricular mass index in hypertension.
abstract: Left ventricular hypertrophy (LVH) is a risk factor for cardiovascular disease. Elevated natriuretic peptides in LVH have spurred interest that biomarkers may play a role in screening programs. Adrenomedullin (ADM) is a 52-amino acid peptide mediating vasorelaxation, natriuresis, and diuresis. The midregional portion of proADM (MRproADM) is secreted stoichiometrically with ADM; hence, it can be used as a surrogate marker of ADM. We compared the diagnostic performance of MRproADM for the detection of LVH with N-terminal pro-B-type natriuretic peptide (NTproBNP). Two hundred fifty-three hypertensive patients were derived from a local screening study. The MRproADM and NTproBNP levels were assayed using immunoluminometric assays. The MRproADM levels were significantly elevated in patients with LVH than those without (mean [SD]: 0.73 [0.25] vs 0.59 [0.18] nmol/L, P < .001). In multivariate analyses, male sex (P < .001) and log MRproADM (P = .003) retained significance for detecting LVH. Receiver operating characteristic curve for MRproADM yielded an area under the curve of 0.71; confidence interval, 0.62-0.81; P < .001, superior to NTproBNP. An optimal cutoff value for MRproADM as an indicator of LVH was 0.50 nmol/L, with a sensitivity, specificity, and negative predictive value of 90.5%, 36.5%, and 95.1%, respectively. The high negative predictive value of the MRproADM assay allows it to be used as a rule-out test for LVH when stratifying patients into high or low risk. Patients who test positive would necessitate echocardiography, enabling better resource allocation.
authors.affiliation: Departmet of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, United Kingdom. sanjay1bhandari@hotmail.com
authors.forename: Sanjay S
authors.initials: SS
authors.lastname: Bhandari
authors.forename: Joan E
authors.initials: JE
authors.lastname: Davies
authors.forename: Joachim
authors.initials: J
authors.lastname: Struck
authors.forename: Leong L
authors.initials: LL
authors.lastname: Ng
mesh_terms: D053607:Adrenomedullin / Q000378:metabolism*; D000368:Aged; D006332:Cardiomegaly / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011498:Protein Precursors / Q000378:metabolism*
chemical_list: D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin