Prognostic Value of Adrenomedullin in Patients with Left Ventricular Systolic Dysfunction After an Acute Myocardial Infarction

ABSTRACT This study sought to assess the prognostic impact of adrenomedullin ADM after an acute myocardial infarction (AMI). Adrenomedullin (ADM) is elevated in heart failure (HF) and after AMI and compared it with N-terminal pro-B-type natriuretic peptide (NTproBNP), a marker of death and HF. We measured plasma ADM and NTproBNP in 60 consecutive post-ST elevated AMI patients with systolic dysfunction (< EF 50%), (45 men, represents 75% with mean age57.6±8.4 years old), 3 to 5 days after chest pain onset. Mean age of studied patients was 57.6±8.4 years old (Range 35-80). Males constituted 73.3% of our study population (44 males), we found mean NYHA 2.8, mean Killip class of 2.9 and mean TIMI risk score of 8.3. Follow-up was done at 90 days. Forty eight patients survived (80%). Two patients experienced cerebrovascular events (3.3%), two patients experienced re-infarction (3.3%), and seven patients experienced life-threatening arrhythmias (11.7%). ADM had proved to have a significant prognostic value in predicting mortality if compared to Pro-BNP as evidenced by plotting the ROC curve that revealed AUC for ADM to be 0.977 and 0.775 for Pro-BNP. The same significant higher prognostic power for ADM applies for predicting MACE using ROC curve and estimating AUC. Multivariate analysis showed that ADM was the only predictor for MACE. ADM: (OR 1.62, CI 95%: 1.19-2.20, P value .002). The ADM system is activated after AMI. The ADM may represent a clinically useful marker of prognosis in patients with LV dysfunction after an acute AMI. Keywords: ADM (adrenomedullin), AMI (acute myocardial infarction), AUC (area under the curve, MACE (major adverse cardiovascular events). REFERENCES De Lemos JA. Benchmarks for the assessment of novel cardiovascular biomarkers. Circulation 2007;115: 949-52. Chidsey CA, Braunwald E, Morrow AG. Catecholamine excretion and cardiac stores of norepinephrine in congestive heart failure. Am J Med 1965;39:442-51. Daniels LB, Maisel AS. Natriuretic peptides. J Am Coll Cardiol 2007;50:2357-68. Fujisawa, Y., Nagai Y., Miyatake A et al., 2004. Renal effects of new member of adrenomedullin family, adrenomedullin2 in rats. Eur. J. Pharmacol., 497(1): 75-80. Garrone, P.; Biondi-Zoccai, G. & Salvetti, I. (2009). Quantitative coronary angiography in the current era: principles and applications. J Interv Cardiol 22:527-536. Jougasaki M, Wei CM, McKinley LJ,Burnett JC Jr. Elevation of circulating and ventricular adrenomedullin in human congestive heart failure. Circulation 1995;92:286-9 Klip IT1, Voors AA, Anker SD, Hillege HL, Struck J,OPTIMAAL investigators. Heart. 2011 Jun;97(11):892-8. doi: 10.1136/hrt.2010.210948. Epub 2011 Mar 17. Tania Luthra, Rahul Agarwal, Mamidala Estari, Uma Adepally, Subhabrata Sen. A novel library of -arylketones as potential inhibitors of α-glucosidase: Their design, synthesis, in vitro and in vivo studies. Nature-Scientific Reports, 2017, 7(1), 1-13. DOI: 10.1038/s41598- 017-13798-y Nagaya N, Satoh T, Nishikimi T, et al. Hemodynamic, renal, and hormonal effects of adrenomedullin infusion in patients with congestive heart failure. Circulation 2000;101:498-503. Phillip Haaf Raphael twerenbold ,Tobias Reichlin ,Jonathan Faoro ,Miriam Reiter,ChristopheMeune, Department of Internal Medicine, Division of Cardiology, University Hospital, Basel, Switzerland. International journal of cardiology (Impact Factor: 6.18). 11/2012; 168(2). DOI: 10.1016/j.ijcard.2012.10.025 Tang WH, Francis GS, Morrow DA, et al. National Academy of Clinical Biochemistry Laboratory Medicine practice guidelines: clinical utilization of cardiac biomarkers Sugiura T, Takase H, Toriyama T, Goto T, Ueda R, Dohi Y. Circulating levelsb of myocardial proteins predict future deterioration of congestive heart failure. J Card Fail 2005;11:504-9. Vickery S, Price CP, John RI, et al. B‑type natriuretic peptide (BNP) and amino-terminal proBNP in patients with CKD: relationship to renal function and left ventricular hypertrophy. Am J Kidney Dis 2005;46:610-20. Zhengbing ,Kai Wu ,Xiaoping chen, Xin Shang ,Biying Hong ,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China, 610041. Peptides (Impact Factor: 2.61). 03/2013; 43. DOI: 10.1016/j.peptides.2013.03.00