title: Mid-region pro-adrenomedullin adds predictive value to clinical predictors and Framingham risk score for long-term mortality in stable outpatients with heart failure.
abstract: OBJECTIVE
  The aim of this study was to evaluate the long-term prognostic utility of mid-region prohormone adrenomedullin (MR-proADM) in stable outpatients with heart failure (HF).
  
  
  RESULTS
  Echocardiogram and serum for MR-proADM and BNP levels were obtained in 724 stable outpatients. These patients were followed for up to 6 years for the primary endpoint of all-cause mortality. There were 198 stage A patients, 328 stage B patients, and 200 stage C/D patients, with an average age of 68 ± 12 years. There were 195 deaths during the 6-year follow-up period. MR-proADM was predictive of mortality in the overall patient population. The predictive value of MR-proADM for long-term mortality was independent of BNP, echocardiographic indices of structural heart disease, clinical predictors of mortality, and the Framingham risk score. Patients with elevated MR-proADM had significantly increased risk for mortality in stage A and stage C/D HF, with hazard ratio (HR) 3.780, P < 0.001 and HR 2.744, P < 0.001, respectively. There was a trend toward increased mortality in patients with elevated MR-proADM and stage B HF (HR 1.579, P = 0.05005). MR-proADM added incremental predictive value to clinical predictors and the Framingham risk score.
  
  
  CONCLUSIONS
  MR-proADM was a potent independent predictor of long-term all-cause mortality in stable outpatients with stage A-D HF, especially in patients in stage A and stage C/D HF. MR-proADM added incremental predictive value to clinical predictors and the Framingham risk score.
authors.affiliation: Division of Cardiology, University of California San Diego Medical Center, San Diego, CA, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xue
authors.forename: Pam
authors.initials: P
authors.lastname: Taub
authors.forename: Navaid
authors.initials: N
authors.lastname: Iqbal
authors.forename: Arrash
authors.initials: A
authors.lastname: Fard
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood; D062072:Patient Acuity; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C574167:mid-regional pro-adrenomedullin, human; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin
keywords: BNP; Framingham risk score; Heart failure; Mid-region prohormone adrenomedullin; Mortality