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Increase in plasma adrenomedullin in patients with heart failure characterised by diastolic dysfunction
1Department of Medicine, Queen Mary Hospital and the Institute of Cardiovascular Science and Medicine, University of Hong Kong, Pokfulam Road, Hong Kong. cmyua@hkucc.hku.hk
Insights
Plasma adrenomedullin levels are elevated in heart failure patients, particularly those with restrictive filling patterns indicating diastolic dysfunction. These levels do not correlate with systolic dysfunction severity.
Area of Science:
- Cardiology
- Biochemistry
- Internal Medicine
Background:
- Heart failure is a complex condition often involving impaired systolic and diastolic function.
- Plasma biomarkers are crucial for assessing heart failure severity and guiding treatment.
- Adrenomedullin is a peptide hormone with vasodilatory and natriuretic properties, implicated in cardiovascular regulation.
Purpose of the Study:
- To investigate the relationship between plasma adrenomedullin concentrations and the severity of diastolic dysfunction in patients diagnosed with heart failure.
- To determine if plasma adrenomedullin levels correlate with systolic function parameters in heart failure patients.
Main Methods:
- A prospective study was conducted involving 77 patients with acute heart failure.
- Echocardiography with Doppler studies and plasma adrenomedullin concentration measurements (radioimmunoassay) were performed.
- Patients were categorized based on ejection fraction and diastolic filling patterns.
Main Results:
- Forty percent of patients had isolated diastolic dysfunction; the remainder had depressed ejection fraction.
- Patients with systolic heart failure and a restrictive filling pattern exhibited significantly higher plasma adrenomedullin levels compared to other groups.
- Plasma adrenomedullin did not correlate with ejection fraction or New York Heart Association functional class; restrictive filling pattern was the sole independent predictor of elevated levels.
Conclusions:
- Plasma adrenomedullin concentrations in heart failure are primarily influenced by the presence and severity of diastolic dysfunction, especially a restrictive filling pattern.
- Elevated adrenomedullin is strongly associated with restrictive diastolic filling, suggesting its role as a marker for this specific dysfunction.
- No significant correlation was found between plasma adrenomedullin levels and systolic dysfunction in the study population.
Objective:
To investigate the relation between plasma adrenomedullin and the severity of diastolic dysfunction in patients with heart failure.
Design:
Prospective study.
Setting:
University teaching hospital.
Patients:
77 patients (mean (SEM) age 66.3 (1.2) years; 75% male) who were being followed in the outpatient clinic after admission to hospital for acute heart failure.
Interventions:
Same day echocardiography with Doppler studies; determination of venous adrenomedullin concentration by radioimmunoassay.
Main Outcome Measures:
Plasma adrenomedullin concentration and its correlation with systolic and diastolic function.
Results:
31 patients (40%) had isolated diastolic dysfunction (ejection fraction > 50%), and the remaining 46 had a depressed ejection fraction (< 50%). Of the patients with diastolic dysfunction, 17 had a restrictive filling pattern. In all but one of these there was coexisting systolic failure (chi(2) = 10.7, p = 0.001). Patients with systolic heart failure and a restrictive filling pattern (group 1, n = 16) had a higher plasma adrenomedullin than those with systolic failure and a non-restrictive filling pattern (group 2, n = 30) or with isolated diastolic heart failure and a non-restrictive filling pattern (group 3, n = 30) (mean (SEM): 91.7 (21.1) v 38.4 (8.8) v 34.0 (6.5) pmol/l, both p < 0.05). All heart failure values were higher (p < 0.01) than the control value (6.9 (1.2) pmol/l). Ejection fraction and left ventricular dimensions were similar in groups 1 and 2. Plasma adrenomedullin did not correlate with ejection fraction or New York Heart Association functional class. Stepwise multiple regression analysis showed that the presence of a restrictive filling pattern was the only independent variable associated with a high plasma adrenomedullin.
Conclusions:
Plasma adrenomedullin concentrations in patients with heart failure are determined by the presence of diastolic dysfunction, and are especially raised in the presence of a restrictive filling pattern. There appears to be no correlation with systolic dysfunction.