title: Midregional proadrenomedullin (MR-proADM) is a powerful predictor of early death in AL amyloidosis.
abstract: BACKGROUND
  Cardiac biomarkers play a major role in the identification of patients at risk of early death in AL amyloidosis, and a staging system based on amino-terminal pro-natriuretic peptide type-B (NT-proBNP) and troponins (cTn) is used for prognostic stratification. Adrenomedullin is produced by several tissues including the heart, and portends a poor prognosis in heart diseases. We investigated the ability of midregional proadrenomedullin (MR-proADM) to predict early death in AL amyloidosis.
  
  
  METHODS
  One-hundred and thirty consecutive patients with newly-diagnosed AL amyloidosis were prospectively enrolled. The impact on survival of NT-proBNP, cTnI and MR-proADM was evaluated.
  
  
  RESULTS
  The concentration of MR-proADM correlated with systolic and diastolic function, but did not reflect the amount of amyloid deposited in the heart. Moreover, MR-proADM was associated with non-cardiac markers of advanced disease. The staging system based on NT-proBNP and cTnI identified high-risk subjects, but could not discriminate good-risk and intermediate-risk patients. Conversely, a staging system based on MR-proADM and cTnI identified 3 groups with significantly different survivals.
  
  
  CONCLUSIONS
  Midregional-proADM is a powerful prognostic marker in AL amyloidosis, which may not only reflect cardiac dysfunction but also widespread systemic disease, and can be combined with cTn for detecting patients at risk of early death.
authors: Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo and Department of Biochemistry, University of Pavia, Pavia, Italy.
authors: Giovanni
authors: G
authors: Palladini
authors: Alessandra
authors: A
authors: Barassi
authors: Stefano
authors: S
authors: Perlini
authors: Paolo
authors: P
authors: Milani
authors: Andrea
authors: A
authors: Foli
authors: Paola
authors: P
authors: Russo
authors: Riccardo
authors: R
authors: Albertini
authors: Laura
authors: L
authors: Obici
authors: Francesca
authors: F
authors: Lavatelli
authors: Gabriele
authors: G
authors: Sarais
authors: Simona
authors: S
authors: Casarini
authors: Remigio
authors: R
authors: Moratti
authors: Gian Vico
authors: GV
authors: Melzi d'Eril
authors: Giampaolo
authors: G
authors: Merlini
mesh_terms: D053607:Adrenomedullin / Q000378:metabolism*; D000368:Aged; D000682:Amyloid / Q000378:metabolism*; D000686:Amyloidosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015415:Biomarkers; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000209:etiology / Q000401:mortality; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D011498:Protein Precursors / Q000378:metabolism*; D019210:Troponin I / Q000097:blood; D014463:Ultrasonography
chemical_list: D000682:Amyloid; D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; D019210:Troponin I; C518669:amyloid L, human; C109794:pro-brain natriuretic peptide (1-76); C088633:proadrenomedullin; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin