title: Mid-regional pro-adrenomedullin in patients with acute dyspnea: Data from the Akershus Cardiac Examination (ACE) 2 Study.
abstract: BACKGROUND
  Mid-regional pro-adrenomedullin (MR-proADM) is a surrogate marker for adrenomedullin; a hormone that attenuates myocardial remodeling. Accordingly, we hypothesized that MR-proADM could provide diagnostic and prognostic information in patients with acute dyspnea.
  
  
  RESULTS
  We measured MR-proADM by a commercial ELISA on hospital admission in 311 patients with acute dyspnea and compared the utility of MR-proADM with N-terminal pro-B-type natriuretic peptide (NT-proBNP). Blood samples were also available after 24h (n=232) and before discharge (n=94). The principal diagnosis of the index hospitalization was determined by an adjudication committee. MR-proADM concentrations on hospital admission were higher in patients with acute heart failure (HF; n=143) vs. patients hospitalized with non-HF-related dyspnea (n=168): 1.31 (Q1-3 0.97-1.89) vs. 0.85 (0.59-1.15) nmol/L; p<0.001. The receiver-operating characteristics area under the curve (ROC-AUC) for MR-proADM to diagnose HF was 0.77 (95% CI 0.72-0.82) and 0.86 (0.82-0.90) for NT-proBNP. During a median follow-up of 816days, 66/143 patients (46%) with acute HF and 35/84 patients (42%) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) died; p=0.58 between groups. In multivariate Cox regression analyses, admission MR-proADM concentrations were associated with mortality in patients with acute HF (HR 5.90 [3.43-10.13], p<0.001), but not in patients with AECOPD. Admission MR-proADM concentrations also improved risk stratification in acute HF as assessed by the net reclassification index. MR-proADM concentrations decreased from admission to later time points.
  
  
  CONCLUSIONS
  Admission MR-proADM concentrations provide strong prognostic information in patients with acute HF, but modest diagnostic information in patients with acute dyspnea.
authors.affiliation: Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, University of Oslo, Oslo, Norway.
authors.forename: Mohammad Osman
authors.initials: MO
authors.lastname: Pervez
authors.affiliation: Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, University of Oslo, Oslo, Norway.
authors.forename: Magnus Nakrem
authors.initials: MN
authors.lastname: Lyngbakken
authors.affiliation: Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, University of Oslo, Oslo, Norway.
authors.forename: Peder Langeland
authors.initials: PL
authors.lastname: Myhre
authors.affiliation: Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, University of Oslo, Oslo, Norway.
authors.forename: Jon
authors.initials: J
authors.lastname: Brynildsen
authors.affiliation: Section for Medical Biochemistry, Division of Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Eva Camilla
authors.initials: EC
authors.lastname: Langsjøen
authors.affiliation: Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, University of Oslo, Oslo, Norway.
authors.forename: Arne Didrik
authors.initials: AD
authors.lastname: Høiseth
authors.affiliation: Center for Heart Failure Research, University of Oslo, Oslo, Norway; Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Christensen
authors.affiliation: Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, University of Oslo, Oslo, Norway.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
authors.affiliation: Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, University of Oslo, Oslo, Norway. Electronic address: helge.rosjo@medisin.uio.no.
authors.forename: Helge
authors.initials: H
authors.lastname: Røsjø
mesh_terms: D000208:Acute Disease; D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004417:Dyspnea / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C574167:mid-regional pro-adrenomedullin, human; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin
keywords: Biomarker; Cardiovascular; Heart failure; MR-proADM; Prognosis