Comparison of Plasma Levels of Mature Adrenomedullin and Natriuretic Peptide as Markers of Cardiac Function in Hemodialysis Patients with Coronary Artery Disease

Abstract

Background: It has been suggested that, like ANP and BNP, high plasma levels of mature adrenomedullin (mAM) indirectly reflect the severity of heart failure or renal failure. However, the relationship between mAM levels and hemodynamics and cardiac function has not been examined in hemodialysis (HD) patients with coronary artery disease (CAD). The best marker, among mAM, ANP and BNP, for left-ventricular function in those patients is also unclear. Patients and Methods: Plasma levels of mAM, total AM (tAM), ANP and BNP were determined before HD in chronic HD patients with CAD (group 1; n = 17) and were compared with those of HD patients without cardiac disease (group 2; n = 22). We examined their relationship to hemodynamics and cardiac function in group 1 using data obtained by cardiac catheterization. Results: Plasma levels of ANP and BNP were significantly higher in group 1 than in group 2, but there was no significant difference in plasma levels of mAM and tAM between the two patient groups. Plasma levels of both mAM and tAM significantly correlated with right atrial pressure (RAP), and only plasma tAM levels correlated with pulmonary artery pressure (PAP) and pulmonary artery wedge pressure (PAWP). However, no correlations were found between levels of the two forms of AM and ejection fraction (EF). In contrast, plasma ANP and BNP levels significantly correlated with both PAP and PAWP, and also with EF, although they did not correlate with RAP. The correlation of PAP and PAWP with ANP and BNP levels was closer than that with tAM levels. The most significant correlation was between BNP levels and EF (r = –0.756, p < 0.0001). Conclusions: Our results suggest that the mAM level may be less useful than natriuretic peptide levels as a marker of cardiac function in HD patients with CAD, and that the BNP level might be the best indicator of left-ventricular function. In addition, cardiac disease such as CAD may have a minor impact on mAM levels compared to renal failure.

Diagnostic Accuracy and Prognostic Relevance of the Measurement of Cardiac Natriuretic Peptides: A Review

“…The usefulness of CNH assays as diagnostic markers of cardiac function in patients with end-stage renal disease is also doubtful, especially when taking into account the different behavior of CNHs and their N-terminal propeptides and when comparing it with other biomarkers and/or hemodynamic indices (6,27,124,128 ). Whereas only few data are available on NT-proBNP assays, BNP assays seem to show better diagnostic accuracy and clinical performance as prognostic markers than ANP assays.…”

Roles of adrenomedullin 2 in regulating the cardiovascular and sympathetic nervous systems in conscious rats

“…AM is a multifunctional peptide that exhibits various actions, such as cardiovascular, renal, and respiratory regulation, as well as central nervous system regulation and regulation of other hormone secretions (2,10,12,16,21,28). AM has also been implicated in various disease states, such as heart failure and renal dysfunction (1,7,9,14,17,18,20). Recently, a new member of the calcitonin generelated peptide (CGRP) family, adrenomedullin 2 (AM2) or intermedin (IMD), was identified (23, 26).…”

Adrenomedullin Protects Against Myocardial Apoptosis After Ischemia/Reperfusion Through Activation of Akt-GSK Signaling

“…For example, plasma AM levels are increased in patients with essential hypertension, cardiac hypertrophy, heart failure, and renal disease. [3][4][5] Thus, elevated AM production could be a biological attempt to compensate for cardiac and renal damage. Transgenic mice overexpressing the AM gene have decreased mean blood pressure with no change in heart rate.…”