title: Increased Symmetric Dimethylarginine Level Is Associated with Worse Hospital Outcomes through Altered Left Ventricular Ejection Fraction in Patients with Acute Myocardial Infarction.
abstract: OBJECTIVE
  We aimed to investigate whether SDMA- symmetric dimethylarginine -the symmetrical stereoisomer of ADMA- might be a marker of left ventricular function in AMI.
  
  
  BACKGROUND
  Asymmetric dimethylarginine (ADMA) has been implicated in the prognosis after acute myocardial infarction (AMI) and heart failure (HF).
  
  
  METHODS
  Cross sectional prospective study from 487 consecutive patients hospitalized <24 hours after AMI. Patients with HF on admission were excluded. Serum levels of ADMA, SDMA and L-arginine were determined using HPLC. Glomerular filtration rate (eGFR) was estimated based on creatinine levels. Outcomes were in-hospital severe HF, as defined by Killip class >2, and death.
  
  
  RESULTS
  Patients were analysed based on SDMA tertiles. Sex, diabetes, dyslipidemia, and prior MI were similar for all tertiles. In contrast, age and hypertension increased across the tertiles (p<0.001). From the first to the last tertile, GRACE risk score was elevated while LVEF and eGFR was reduced. The rate of severe HF and death were gradually increased across the SDMA tertiles (from 0.6% to 7.4%, p = 0.006 and from 0.6% to 5.0%, p = 0.034, respectively). Backward logistic multivariate analysis showed that SDMA was an independent estimate of developing severe HF, even when adjusted for confounding (OR(95%CI): 8.2(3.0-22.5), p<0.001). Further, SDMA was associated with mortality, even after adjustment for GRACE risk score (OR(95%CI): 4.56(1.34-15.52), p = 0.015).
  
  
  CONCLUSIONS
  Our study showed for the first time that SDMA is associated with hospital outcomes, through altered LVEF and may have biological activity beyond renal function.
authors.affiliation: Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM UMR 866, UFR Sciences de Santé, Université de Bourgogne, Dijon, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Lorin
authors.affiliation: Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM UMR 866, UFR Sciences de Santé, Université de Bourgogne, Dijon, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Guilland
authors.affiliation: Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM UMR 866, UFR Sciences de Santé, Université de Bourgogne, Dijon, France.|Service de Cardiologie, CHU Dijon, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Stamboul
authors.affiliation: Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM UMR 866, UFR Sciences de Santé, Université de Bourgogne, Dijon, France.|Service de Cardiologie, CHU Dijon, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Guenancia
authors.affiliation: Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM UMR 866, UFR Sciences de Santé, Université de Bourgogne, Dijon, France.|Service de Cardiologie, CHU Dijon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.affiliation: Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM UMR 866, UFR Sciences de Santé, Université de Bourgogne, Dijon, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Rochette
authors.affiliation: Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM UMR 866, UFR Sciences de Santé, Université de Bourgogne, Dijon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Vergely
authors.affiliation: Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM UMR 866, UFR Sciences de Santé, Université de Bourgogne, Dijon, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
mesh_terms: D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology; D009569:Nitric Oxide / Q000097:blood; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000503:physiopathology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D009569:Nitric Oxide; C024917:symmetric dimethylarginine; D001120:Arginine