Clinical value of pre‐discharge bio‐adrenomedullin as a marker of residual congestion and high risk of heart failure hospital readmission

Pandhi, Paloma; Maaten, Jozine M. ter; Emmens, Johanna E.; Struck, Joachim; Bergmann, Andreas; Cleland, John G.F.; Givertz, Michael M.; Metra, Marco; O’Connor, Christopher M.; Teerlink, John R.; Ponikowski, Piotr; Cotter, Gad; Davison, Beth A.; Veldhuisen, Dirk J. van; Voors, Adriaan A.

doi:10.1002/ejhf.1693

Cited by 41 publications

(59 citation statements)

References 28 publications

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“…The preservation of endothelial integrity and influence on fluid balance might explain the important role of ADM in HF, where volume challenge, vascular leakage and formation of interstitial oedema are crucial. Recently, bio‐ADM level was shown to be a strong predictor of fluid overload in new‐onset or worsening HF, proposing bio‐ADM as a marker of congestion 10,26 . Besides its vasoactivity, 27 effects of ADM in the cardiovascular system include positive inotropy, inhibition of cardiomyocyte hypertrophy as well as natriuretic, angiogenic and anti‐inflammatory properties 6 .…”

Section: Discussionmentioning

confidence: 99%

Increased concentrations of bioactive adrenomedullin subsequently to angiotensin‐receptor/neprilysin‐inhibitor treatment in chronic systolic heart failure

Arfsten

Goliasch

Bartko

et al. 2020

Brit J Clinical Pharma

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The clinically investigated rationale for neprilysin (NEP)-inhibition by angiotensinreceptor-NEPinhibitor (ARNi) therapy is to induce elevations in endogenous natriuretic peptides. NEP, however, cleaves a broad spectrum of substrates, which partially hold significant implications in heart failure with reduced ejection fraction (HFrEF). The effect of NEP inhibition on these peptides has not been investigated thoroughly. This study explored the response of adrenomedullin (ADM) regulation to the initiation of ARNi. Methods: Seventy-four patients with stable HFrEF and initiation of ARNi were prospectively enrolled, 67 patients on continuous angiotensin-converting-enzyme inhibitor(ACEi)/angiotensin-receptor blocker (ARB) therapy served as control. Plasma bioactive-ADM (bio-ADM), mid-regional-pro-ADM (MR-proADM), B-typenatriuretic peptide (BNP) and N-terminal-pro-BNP (NT-proBNP) were determined at baseline, short-term, 1-year and 2-year follow up. Results: Following ARNi initiation both bio-ADM and MR-proADM concentrations were significantly increased at early and long-term follow up (bio-ADM [pg/mL]: 26.0

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Section: Discussionmentioning

confidence: 99%

Increased concentrations of bioactive adrenomedullin subsequently to angiotensin‐receptor/neprilysin‐inhibitor treatment in chronic systolic heart failure

Arfsten

Goliasch

Bartko

et al. 2020

Brit J Clinical Pharma

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“…Bio‐adrenomedullin (bio‐ADM) is a possible marker of congestion . Pandhi et al . confirmed that high bio‐ADM levels at discharge are strongly associated with residual congestion in patients with acute HF.…”

Section: Acute Heart Failurementioning

confidence: 98%

“…confirmed that high bio‐ADM levels at discharge are strongly associated with residual congestion in patients with acute HF. Moreover, combined with high dose of loop diuretics, high bio‐ADM was associated with a four‐fold increased risk of HF rehospitalization at 60 days . Natriuretic peptides have a main role in the diagnosis and stratification of HF patients .…”

Section: Acute Heart Failurementioning

confidence: 99%

April 2020 at a glance: epidemiology, prevention, and biomarkers

Adamo¹,

Lombardi

Metra

2020

European J of Heart Fail

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Data about epidemiology of heart failure (HF) in Europe are largely insufficient. 1,2 The Heart Failure Association Atlas registry is the first European study providing information about HF epidemiology, resource, and reimbursement policies for HF management. 3 Studies defining prevalence and outcome of HF in Asia are also limited. 4,5 The Heart Failure Registry of Patient Outcomes (HERO) includes patients admitted for HF in 73 Chinese centres. In-hospital mortality rate was 3.2%, and incidence of early mortality or readmission was 22%. 6 Incidence and trends of cardiogenic shock complicating acute myocardial infarction have recently been reported in a Danish cohort. 7 . In this issue, French data are provided. The prevalence of cardiogenic shock after acute myocardial infarction decreased from 2005 (5.9%) to 2015 (2.8%), whilst the use of invasive management increased over time. In-hospital mortality remained unchanged. 8

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“…288 Mid-regional pro-adrenomedullin and bio-adrenomedullin provide a great accuracy in diagnosis of acute HF and detection of residual congestion. 289,290 Elevated levels of blood lactate, associated with hypoperfusion, and markers of multi-organ injury/dysfunction are predictors of poorer outcomes. [291][292][293] Worsening renal function is only associated with adverse events in patients without decreased BNP.…”

Section: Managementmentioning

confidence: 99%

“…Higher levels of mid‐regional pro‐adrenomedullin and its active form, bio‐adrenomedullin, were observed in the presence of volume overload and have been proposed as markers of congestion 288 . Mid‐regional pro‐adrenomedullin and bio‐adrenomedullin provide a great accuracy in diagnosis of acute HF and detection of residual congestion 289,290 . Elevated levels of blood lactate, associated with hypoperfusion, and markers of multi‐organ injury/dysfunction are predictors of poorer outcomes 291–293 .…”

Section: Acute Heart Failurementioning

confidence: 99%

Heart failure in the last year: progress and perspective

et al. 2020

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Research about heart failure (HF) has made major progress in the last years. We give here an update on the most recent findings. Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM‐HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA‐HF and EMPEROR‐Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65–0.85; P < 0.001 and HR 0.75; 95% CI 0.65–0.86; P < 0.001, respectively]. Second, vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo (HR 0.90; 95% CI 0.82–0.98; P = 0.02). On the other hand, both the diagnosis and treatment of HF with preserved ejection fraction, as well as management of advanced HF and acute HF, remain challenging. A better phenotyping of patients with HF would be helpful for prognostic stratification and treatment selection. Further aspects, such as the use of devices, treatment of arrhythmias, and percutaneous treatment of valvular heart disease in patients with HF, are also discussed and reviewed in this article.

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Clinical value of pre‐discharge bio‐adrenomedullin as a marker of residual congestion and high risk of heart failure hospital readmission

Cited by 41 publications

References 28 publications

Increased concentrations of bioactive adrenomedullin subsequently to angiotensin‐receptor/neprilysin‐inhibitor treatment in chronic systolic heart failure

Increased concentrations of bioactive adrenomedullin subsequently to angiotensin‐receptor/neprilysin‐inhibitor treatment in chronic systolic heart failure

April 2020 at a glance: epidemiology, prevention, and biomarkers

Heart failure in the last year: progress and perspective

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