Bio-adrenomedullin as a marker of congestion in patients with new-onset and worsening heart failure

被引:85
作者
ter Maaten, Jozine M.
Kremer, Daan
Demissei, Biniyam G. [1 ]
Struck, Joachim [2 ]
Bergmann, Andreas [2 ]
Anker, Stefan D. [3 ,4 ,5 ,6 ]
Ng, Leong L. [7 ,8 ]
Dickstein, Kenneth [9 ,10 ]
Metra, Marco [11 ]
Samani, Nilesh J. [7 ,8 ]
Romaine, Simon P. R. [7 ,8 ]
Cleland, John [12 ]
Girerd, Nicolas [13 ]
Lang, Chim C. [14 ]
van Veldhuisen, Dirk J. [1 ]
Voors, Adriaan A. [1 ]
机构
[1] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands
[2] Sphingotec GmbH, Hennigsdorf, Germany
[3] Charite Univ Med Berlin, Dept Cardiol CVK, Berlin, Germany
[4] Charite Univ Med Berlin, BCRT, Berlin, Germany
[5] Charite Univ Med Berlin, German Ctr Cardiovasc Res DZHK, Berlin, Germany
[6] Univ Med Ctr Gottingen, Dept Cardiol & Pneumol, Gottingen, Germany
[7] Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics, England
[8] Glenfield Hosp, NIHR Leicester Biomed Res Ctr, Leicester, Leics, England
[9] Univ Bergen, Bergen, Norway
[10] Stavanger Univ Hosp, Stavanger, Norway
[11] Univ Brescia, Inst Cardiol Radiol Sci & Publ Hlth, Dept Med & Surg Specialties, Brescia, Italy
[12] Imperial Coll London, Royal Brompton & Harefield Hosp, Natl Heart & Lung Inst, London, England
[13] Univ Lorrain, CHU Nancy, Inserm CIC1433, Nancy, France
[14] Univ Dundee, Ninewells Hosp & Med Sch, Div Mol & Clin Med, Dundee, Scotland
关键词
Bio-adrenomedullin; Pro-adrenomedullin; Adrenomedullin; Heart failure; Congestion; EUROPEAN-SOCIETY; HOSPITALIZATION; ASSOCIATION; GUIDELINES; DIAGNOSIS; BIOMARKER; ESC;
D O I
10.1002/ejhf.1437
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Secretion of adrenomedullin (ADM) is stimulated by volume overload to maintain endothelial barrier function, and higher levels of biologically active (bio-) ADM in heart failure (HF) are a counteracting response to vascular leakage and tissue oedema. This study aimed to establish the value of plasma bio-ADM as a marker of congestion in patients with worsening HF. Methods and results The association of plasma bio-ADM with clinical markers of congestion, as well as its prognostic value was studied in 2179 patients with new-onset or worsening HF enrolled in BIOSTAT-CHF. Data were validated in a separate cohort of 1703 patients. Patients with higher plasma bio-ADM levels were older, had more severe HF and more signs and symptoms of congestion (all P < 0.001). Amongst 20 biomarkers, bio-ADM was the strongest predictor of a clinical congestion score (r(2) = 0.198). In multivariable regression analysis, higher bio-ADM was associated with higher body mass index, more oedema, and higher fibroblast growth factor 23. In hierarchical cluster analysis, bio-ADM clustered with oedema, orthopnoea, rales, hepatomegaly and jugular venous pressure. Higher bio-ADM was independently associated with impaired up-titration of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers after 3 months, but not of beta-blockers. Higher bio-ADM levels were independently associated with an increased risk of all-cause mortality and HF hospitalization (hazard ratio 1.16, 95% confidence interval 1.06-1.27, P = 0.002, per log increase). Analyses in the validation cohort yielded comparable findings. Conclusions Plasma bio-ADM in patients with new-onset and worsening HF is associated with more severe HF and more oedema, orthopnoea, hepatomegaly and jugular venous pressure. We therefore postulate bio-ADM as a congestion marker, which might become useful to guide decongestive therapy.
引用
收藏
页码:732 / 743
页数:12
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