Prognostic potential of midregional pro-adrenomedullin following decompensation for systolic heart failure: comparison with cardiac natriuretic peptides.

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. 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). 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 C ，Marx A ，Kaspar M ，Güder G ，Brenner S ，Feldmann C ，Störk S ，Vollert JO ，Ertl G ，Angermann CE ，INH Study Group and the Competence Network Heart Failure ... -  《-》

Comparison of pleural N-terminal pro-B-type natriuretic peptide, midregion pro-atrial natriuretic peptide and mid-region pro-adrenomedullin for the diagnosis of pleural effusions associated with cardiac failure.

The purpose of this study was to compare the diagnostic utility of pleural fluid N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregion pro-atrial natriuretic peptide (MR-proANP) and midregion pro-adrenomedullin (MR-proADM) for discriminating heart failure (HF)-associated effusions. NT-proBNP, MR-proANP and MR-proADM were measured by commercially available methodologies in the pleural fluid of a retrospective cohort of 185 consecutive patients with pleural effusions, of whom 95 had acute decompensated HF. Receiver-operating characteristic and area under the curve (AUC) analyses allowed comparisons of the discriminative properties of these biomarkers to be made at their optimal cut-off points. The diagnostic accuracy of NT-proBNP and MR-proANP for HF as quantified by the AUC was 0.935 and 0.918, respectively, whereas MR-proADM was of limited value (AUC = 0.62). A pleural fluid MR-proANP >260 pmol/L or NT-proBNP >1700 pg/mL argues for HF (likelihood ratio (LR) positive >5), while levels below these cut-off values significantly decrease the probability of having the disease (respective LR negative 0.19 and 0.10). The optimal cut-off points for natriuretic peptides were influenced by age, renal function and body mass index. Finally, both NT-proBNP and the albumin gradient correctly identified more than 80% of those cardiac effusions misclassified as exudates by standard criteria. MR-proANP is as valuable a diagnostic tool as NT-proBNP for diagnosing or excluding HF as the cause of pleural effusion.

Porcel JM ，Bielsa S ，Morales-Rull JL ，Civit C ，Cao G ，Light RW ，Esquerda A ... -  《-》

Predictive value of midregional pro-adrenomedullin compared to natriuretic peptides for incident cardiovascular disease and heart failure in the population-based FINRISK 1997 cohort.

Funke-Kaiser A ，Havulinna AS ，Zeller T ，Appelbaum S ，Jousilahti P ，Vartiainen E ，Blankenberg S ，Sydow K ，Salomaa V ... -  《-》

Midregional proadrenomedullin and growth differentiation factor-15 are not influenced by obesity in heart failure patients.

Sinning C ，Ojeda F ，Wild PS ，Schnabel RB ，Schwarzl M ，Ohdah S ，Lackner KJ ，Pfeiffer N ，Michal M ，Blettner M ，Munzel T ，Kempf T ，Wollert KC ，Kuulasmaa K ，Blankenberg S ，Salomaa V ，Westermann D ，Zeller T ... -  《-》

Comparison of midregional pro-atrial natriuretic peptide with N-terminal pro-B-type natriuretic peptide in predicting survival in patients with chronic heart failure.

von Haehling S ，Jankowska EA ，Morgenthaler NG ，Vassanelli C ，Zanolla L ，Rozentryt P ，Filippatos GS ，Doehner W ，Koehler F ，Papassotiriou J ，Kremastinos DT ，Banasiak W ，Struck J ，Ponikowski P ，Bergmann A ，Anker SD ... -  《-》