title: Asymmetric dimethylarginine predicts clinical outcomes in ischemic chronic heart failure.
abstract: BACKGROUND
  Elevated plasma level of asymmetric dimethylarginine (ADMA) has been reported to be associated with endothelial dysfunction and atherosclerotic risk factors, and may predict adverse cardiovascular events in patients with coronary artery disease. In this study, we aimed to assess the association between plasma ADMA and long-term outcome in patients with angiography-documented ischemic chronic heart failure (HF).
  
  
  RESULTS
  We evaluated 285 patients with ischemic chronic HF and measured their plasma ADMA levels by high performance liquid chromatography. The mean age was 70 ± 12 years and the mean left ventricular ejection fraction was 36 ± 8%. Plasma ADMA levels were positively correlated with NYHA functional class (p < 0.001) and log N-terminal pro-B type natriuretic peptide (NT-proBNP) level (p < 0.001). During the median follow-up period of 2.2 years, we observed 58 major adverse cardiovascular events (MACE) (20.4%) and 95 MACE plus cardiac decompensation (33.3%). Multivariate Cox regression analysis adjusted for age, ejection fraction, renal function and log NT-proBNP level revealed that ADMA might be a significant independent risk factor and the relative risk of MACE and MACE plus cardiac decompensation would increase by 23% and 25% respectively when plasma ADMA level increased by 1 SD of value (p = 0.05 and 0.007).
  
  
  CONCLUSIONS
  In patients with ischemic chronic HF, elevated plasma ADMA levels might be associated with higher NYHA functional classes and elevated NT-proBNP level, and appear to be an independent predictor of long-term adverse clinical outcomes.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chiao-Po
authors.initials: CP
authors.lastname: Hsu
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
authors.forename: Ming-Yi
authors.initials: MY
authors.lastname: Chung
authors.forename: Tse-Min
authors.initials: TM
authors.lastname: Lu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002851:Chromatography, High Pressure Liquid; D017023:Coronary Angiography; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014463:Ultrasonography; D015854:Up-Regulation; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; C018524:N,N-dimethylarginine; D001120:Arginine