Gustav Smith
Associate professor
Bioactive adrenomedullin for assessment of venous congestion in heart failure
Author
Summary, in English
Aims: Bioactive adrenomedullin (bio-ADM) is a vascular-derived peptide hormone that has emerged as a promising biomarker for assessment of congestion in decompensated heart failure (HF). We aimed to evaluate diagnostic and prognostic performance of bio-ADM for HF in comparison to amino-terminal pro-B-type natriuretic peptide (NT-proBNP), with decision thresholds derived from invasive haemodynamic and population-based studies. Methods and results: Normal reference ranges for bio-ADM were derived from a community-based cohort (n = 5060). Correlations with haemodynamic data were explored in a cohort of HF patients undergoing right heart catheterization (n = 346). Mortality and decision cutoffs for bio-ADM was explored in a cohort of patients presenting in the ER with acute dyspnoea (n = 1534), including patients with decompensated HF (n = 570). The normal reference range was 8–39 pg/mL. The area under the receiver operating characteristic curve (AUROC) for discrimination of elevated mean right atrial pressure (mRAP) and pulmonary arterial wedge pressure (PAWP) was 0.74 (95% CI = 0.67–0.79) and 0.70 (95% CI = 0.64–0.75), respectively, with optimal bio-ADM decision cutoff of 39 pg/mL, concordant with cubic spline analyses. NT-proBNP discriminated PAWP slightly better than mRAP (AUROC 0.73 [95% CI = 0.68–0.79] and 0.68 [95% CI = 0.61–0.75]). Bio-ADM correlated with (mRAP, r = 0.55) while NT-proBNP correlated with PAWP. Finally, a bio-ADM decision cutoff of 39 pg/mL associated with 30 and 90 day mortality and conferred a two-fold increased odds of HF diagnosis, independently from NT-proBNP. Conclusions: Bio-ADM tracks with mRAP and associates with measures of systemic congestion and with mortality in decompensated HF independently from NT-proBNP. Our findings support utility of bio-ADM as a biomarker of systemic venous congestion in HF and nominate a decision threshold.
Department/s
- EXODIAB: Excellence of Diabetes Research in Sweden
- Molecular Epidemiology and Cardiology
- Cardiology
- Lund Hemodynamic Lab
- Cardiopulmonary disease - information, support and reception
- WCMM-Wallenberg Centre for Molecular Medicine
- Heart Failure and Mechanical Support
- Cardiovascular Epigenetics
- EpiHealth: Epidemiology for Health
Publishing year
2022
Language
English
Pages
3543-3555
Publication/Series
ESC Heart Failure
Volume
9
Issue
5
Document type
Journal article
Publisher
John Wiley & Sons Inc.
Topic
- Cardiac and Cardiovascular Systems
Keywords
- Bioactive adrenomedullin
- Biomarker
- Congestion
- Haemodynamics
- Heart failure
- Prognosis
Status
Published
Research group
- Molecular Epidemiology and Cardiology
- Lund Hemodynamic Lab
- Cardiopulmonary disease - information, support and reception
- Heart Failure and Mechanical Support
- Cardiovascular Epigenetics
ISBN/ISSN/Other
- ISSN: 2055-5822