title: Plasma asymmetric dimethylarginine and mortality in patients with acute decompensation of chronic heart failure.
abstract: OBJECTIVE
  To investigate the prognostic value of circulating levels of asymmetric dimethylarginine (ADMA) in patients with acute decompensation of (New York Heart Association (NYHA) class III/IV) chronic heart failure and reduced left ventricular ejection fraction.
  
  
  METHODS
  Single-centre prospective observational study.
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  A total of 651 consecutive and eligible hospitalised patients were studied. Patients were divided into four groups according to the quartiles of circulating levels of ADMA upon presentation.
  
  
  METHODS
  Incidence of in-hospital (or 7-day in the case of prolonged hospitalisation), 31-day and 1-year cardiac mortality were the pre-specified study end points.
  
  
  RESULTS
  Cumulative rates of in-hospital, 31-day and 1-year cardiac mortality were 10.6%, 18.7% and 36.4%, respectively. There was a gradual increased risk of in-hospital (p(for trend)=0.011), 31-day (p(for trend)=0.044) and 1-year (p(for trend)<0.001) mortality with increasing ADMA quartiles. After adjustment for possible confounders, patients at the highest ADMA quartile were at significantly higher risk for in-hospital (p=0.042), 31-day (p=0.032) and 1-year (p<0.001) mortality than those in the lowest quartile.
  
  
  CONCLUSIONS
  According to the present results, an elevated circulating level of ADMA is a strong independent predictor of short-term and long-term mortality in patients with acute decompensation of NYHA class III/IV chronic heart failure and reduced left ventricular ejection fraction. ADMA levels upon presentation may confer enhanced risk stratification in this setting.
authors.affiliation: Koletti 56, Piraeus, 18537, Greece. zairis66@otenet.gr
authors.forename: Michael N
authors.initials: MN
authors.lastname: Zairis
authors.forename: Nikoloas G
authors.initials: NG
authors.lastname: Patsourakos
authors.forename: George Z
authors.initials: GZ
authors.lastname: Tsiaousis
authors.forename: Anastassios
authors.initials: A
authors.lastname: Theodossis Georgilas
authors.forename: Andreas
authors.initials: A
authors.lastname: Melidonis
authors.forename: Stamatis S
authors.initials: SS
authors.lastname: Makrygiannis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Velissaris
authors.forename: Pelagia C
authors.initials: PC
authors.lastname: Batika
authors.forename: Kyriakos S
authors.initials: KS
authors.lastname: Argyrakis
authors.forename: Stavros P
authors.initials: SP
authors.lastname: Tzerefos
authors.forename: Athanasios A
authors.initials: AA
authors.lastname: Prekates
authors.forename: Stefanos G
authors.initials: SG
authors.lastname: Foussas
mesh_terms: D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004730:Endothelium, Vascular / Q000503:physiopathology; D004791:Enzyme Inhibitors / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006333:Heart Failure / Q000097:blood* / Q000145:classification / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D004791:Enzyme Inhibitors; C018524:N,N-dimethylarginine; D001120:Arginine