Prognostic potential of midregional pro-adrenomedullin following decompensation for systolic heart failure: comparison with cardiac natriuretic peptides.
AIMS
Whereas guidelines recommend the routine use of natriuretic peptides (NPs) in heart failure (HF) care, the clinical relevance and prognostic potential of midregional pro-adrenomedullin (MR-proADM) is less well established. We aimed to compare the prognostic potential of MR-proADM after acute decompensation for systolic HF with that of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and midregional pro-atrial NP (MR-proANP), to investigate the significance of high/rising MR-proADM, and to evaluate the incremental prognostic yield of repeat measurements.


METHODS AND RESULTS
The Interdisciplinary Network Heart Failure (INH) programme enrolled patients hospitalized for acute systolic HF and followed them for 18 months (100% complete). Of 1022 INH participants, 917 (68 ± 12 years, 28% female) who had biomaterials available were enrolled. High MR-proADM was associated with more impaired left ventricular function, higher comorbidity burden, lower doses of HF medications, and lower likelihood of left ventricular reverse remodelling. Compared with NPs, MR-proADM had superior prognostic significance (concordance index 0.72 for all-cause mortality), improved Cox regression models including NPs (P < 0.001), and was the only biomarker also predicting non-cardiac death (hazard ratio 1.8 vs. 1.0). In the setting of low NPs, patients with high MR-proADM experienced non-cardiac death more often. Six month MR-proADM enhanced models including baseline MR-proADM (P < 0.001) for prediction of all-cause death (net reclassification index: 0.48, 95% confidence interval 0.19-0.78).


CONCLUSION
MR-proADM was found to correlate with the global disease burden in HF and proved a potent prognostic indicator, capturing the risk for both cardiac and non-cardiac death. Serial MR-proADM measurements further enhanced risk assessment, thus facilitating substantial reclassification.
['Morbach|Caroline|C|', 'Marx|Almuth|A|', 'Kaspar|Mathias|M|', 'Güder|Gülmisal|G|', 'Brenner|Susanne|S|', 'Feldmann|Carolin|C|', 'Störk|Stefan|S|', 'Vollert|Jörn O|JO|', 'Ertl|Georg|G|', 'Angermann|Christiane E|CE|', '|||']
D053607:Adrenomedullin D000368:Aged D015415:Biomarkers D005260:Female D005500:Follow-Up Studies D005858:Germany D006333:Heart Failure D006760:Hospitalization D006801:Humans D008297:Male D008875:Middle Aged D020097:Natriuretic Peptide, Brain D010446:Peptide Fragments D011237:Predictive Value of Tests D011379:Prognosis D018570:Risk Assessment D013223:Statistics as Topic D016277:Ventricular Function, Left
Midregional pro-adrenomedullin Heart failure Biomarker Amino-terminal pro-B-type natriuretic peptide Midregional pro-atrial natriuretic peptide Prognosis