Mid-regional pro-adrenomedullin as a novel predictor of mortality in patients with chronic heart failure.
OBJECTIVE
Adrenomedullin (ADM) is a vasodilatory peptide. Its plasma levels or its precursors have not been evaluated in large populations of patients with chronic heart failure (CHF). We sought to explore mid-regional proADM (MR-proADM).


RESULTS
We assessed MR-proADM in 501 CHF patients [age 63 +/- 11 years, New York Heart Association (NYHA) class I/II/III/IV 9/44/39/8%, median N-terminal pro-B-type natriuretic peptide (NT-proBNP) 878 pg/mL (interquartile range-IQR 348-2480 pg/mL), median left ventricular ejection fraction (LVEF) 31% (IQR 25-37%)]. Mid-regional pro-adrenomedullin levels (median 0.64 nmol/L, IQR 0.49-0.87 nmol/L) increased with NYHA class (P < 0.0001). During 1-year follow-up, 70 patients (14%) died. Increasing MR-proADM was a predictor of poor survival at 12 months (hazard ratio 1.82, 95% confidence interval 1.24-2.66, P = 0.002) after multivariable adjustment. In receiver-operating characteristic curve analysis of 12-month survival, the area under the curve for MR-proADM and NT-proBNP was similar (P = 0.3). Comparison of Cox proportional hazard models using the likelihood ratio chi(2) statistic showed that both NT-proBNP and MR-proADM added prognostic value to a base model of LVEF, age, creatinine, and NYHA class. Adding MR-proADM to the base model had stronger prognostic power than adding NT-proBNP (both P < 0.01).


CONCLUSIONS
Mid-regional pro-adrenomedullin is an independent predictor of mortality in CHF patients, which adds prognostic information to NT-proBNP.
von Haehling
Stephan
S
Applied Cachexia Research, Department of Cardiology, Charité Medical School-Campus Virchow-Klinikum, 13353 Berlin, Germany. stephan.von.haehling@web.de
Filippatos
Gerasimos S
GS
Papassotiriou
Jana
J
Cicoira
Mariantonietta
M
Jankowska
Ewa A
EA
Doehner
Wolfram
W
Rozentryt
Piotr
P
Vassanelli
Corrado
C
Struck
Joachim
J
Banasiak
Waldemar
W
Ponikowski
Piotr
P
Kremastinos
Dimitrios
D
Bergmann
Andreas
A
Morgenthaler
Nils G
NG
Anker
Stefan D
SD
D053607:Adrenomedullin / Q000032:analysis* / Q000097:blood; D002318:Cardiovascular Diseases / Q000401:mortality; D016001:Confidence Intervals; D005060:Europe; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014664:Vasodilation
C507862:ADM protein, human; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin