Plasma bioactive adrenomedullin as a prognostic biomarker in acute heart failure

Abstract

Objective To evaluate the prognostic performance of a new biomarker, plasma bioactive adrenomedullin (bio-ADM), for short-term clinical outcomes in acute heart failure. Methods A multicenter prospective cohort study of adult emergency department (ED) patients suspected of having acute heart failure was conducted to evaluate the association between plasma bio-ADM concentration and clinical outcomes. The primary outcome was a composite of the following within 30 days: death, cardiac arrest with resuscitation, respiratory failure, emergency dialysis, acute coronary syndrome, hospitalization >5 days, and repeat ED visit or hospitalization. Prognostic accuracy was evaluated with a non-parametric receiver operating characteristic (ROC) curve. Additionally, a multivariable logistic regression model was constructed to assess the additive prognostic performance of bio-ADM while adjusting for other biomarkers routinely used clinically, including BNP, cardiac troponin I, creatinine, and sodium concentration. Results Two hundred forty-six patients were enrolled, including 85 (34.6%) patients with the primary outcome. Plasma bio-ADM concentrations were higher among patients who experienced the primary outcome (median: 80.5 pg/ml; IQR: 53.7 pg/ml, 151.5 pg/ml) compared to those who did not (median: 54.4 pg/ml; IQR: 43.4 pg/ml, 78.4 pg/ml) (p < 0.01). Area under the ROC curve was 0.70 (95% CI: 0.63, 0.75). After adjusting for the other biomarkers, plasma bio-ADM remained a strong predictor of the primary outcome (adjusted odds ratio per IQR change: 2.68; 95% CI: 1.60, 4.51). Conclusions Bio-ADM concentrations at the time of ED evaluation for acute heart failure were predictive of clinically-important 30-day outcomes, suggesting bio-ADM is a promising prognostic marker for further study.

Adrenomedullin in heart failure: pathophysiology and therapeutic application

“…53 Plasma bio-ADM was measured in 246 patients admitted at the emergency department with suspicion of acute heart failure. 54 Plasma bio-ADM concentrations were higher among patients who experienced a cardiovascular event [median 80.5 pg/mL; interquartile range (IQR) 53.7-151.5 pg/Ml] compared with those who did not (median 54.4 pg/mL; IQR 43.4-78.4 pg/mL) (P < 0.01). After adjusting for the other biomarkers, plasma bio-ADM remained a strong predictor of a cardiovascular event.…”

“…Plasma bio‐ADM concentrations were higher among patients who experienced a cardiovascular event [median 80.5 pg/mL; interquartile range (IQR) 53.7–151.5 pg/Ml] compared with those who did not (median 54.4 pg/mL; IQR 43.4–78.4 pg/mL) ( P < 0.01). After adjusting for the other biomarkers, plasma bio‐ADM remained a strong predictor of a cardiovascular event . Another study showed that bio‐ADM was a marker of impaired haemodynamics, organ dysfunction, and poor prognosis in patients with cardiogenic shock .…”

“…Recently, a new immunoassay that specifically measures biologically active ADM (bio‐ADM) has been developed . Plasma bio‐ADM was measured in 246 patients admitted at the emergency department with suspicion of acute heart failure . Plasma bio‐ADM concentrations were higher among patients who experienced a cardiovascular event [median 80.5 pg/mL; interquartile range (IQR) 53.7–151.5 pg/Ml] compared with those who did not (median 54.4 pg/mL; IQR 43.4–78.4 pg/mL) ( P < 0.01).…”

Novel heart failure biomarkers: why do we fail to exploit their potential?

“…Recently, a sandwich immunoassay has been developed to measure bio-ADM in plasma. Like MR-proADM, bio-ADM levels in acute HF patients were predictive for 30-day outcomes in these emergency department patients [142]. MR-proADM was also predictive for cardiovascular events in the general population [143].…”

Adrenomedullin disulfide bond mimetics uncover structural requirements for AM1 receptor activation

“…Furthermore, it has been shown that ADM is overexpressed in various cancer types, where it acts as a tumor survival factor . Thus, a lot of effort has been made to develop early‐stage diagnostic systems using ADM as a biomarker as well as stabilized ADM analogs for therapeutic applications …”