Copyright © 2000 by the European Society of Cardiology.
Plasma adrenomedullin, a new independent predictor of prognosis in patients with chronic heart failure
a Department of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
d Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France
b Department of Biochemistry, Pitié-Salpêtrière Hospital, Paris, France
c Department of Biostatistics, Pitié-Salpêtrière Hospital, Paris, France
revised June 29, 1999; accepted August 18, 1999
Abstract
Background Adrenomedullin, a potent endogenous vasodilating and natriuretic peptide, may play an important role in the pathophysiology of chronic heart failure. Plasma levels of immunoreactive adrenomedullin were examined for prediction of prognosis in chronic heart failure.
Methods and Results Plasma levels of immunoreactive-ADM (ir-ADM) were measured by radioimmunoassay in 117 chronic heart failure patients with idiopathic or ischaemic cardiomyopathy (mean ejection fraction: 28±10%, in the NYHA functional class I/II/III/IV:8/73/29/7, and treated with ACE inhibitors and diuretics. Plasma levels of immunoreactive adrenomedullin were significantly increased in chronic heart failure patients by comparison to controls (618±293pg.ml–1vs 480±135pg.ml–1,P =0·01). During the follow-up period (237±137 days) 14 cardiovascular deaths and four urgent cardiac transplantations occurred. In the univariate Cox model, immunoreactive adrenomedullin plasma levels were related to prognosis (P=0·004). A multivariate analysis including heart rate, systolic blood pressure, NYHA class, left ventricular ejection fraction, left ventricular echocardiographic end-diastolic diameter, plasma levels of immunoreactive adrenomedullin, endothelin-1, norepinephrine and atrial natriuretic peptide was performed: plasma levels of immunoreactive adrenomedullin (P=0·03), of endothelin-1 (P=0·0001), and systolic blood pressure (P=0·003) were significantly associated with outcome.
Conclusion Our results suggest that elevated plasma levels of immunoreactive adrenomedullin are an independent predictor of prognosis in predominantly mild to moderate chronic heart failure treated by conventional therapy and provide additional prognostic information.
Key Words: Adrenomedullin, chronic heart failure, prognosis
f1 Correspondence: Prof M. Komajda, Service de Cardiologie, Hôpital Pitié-Salpêtrière, 47–83 Boulevard de l'Hôpital, 75913 Paris, France.
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