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Increased plasma adrenomedullin in acute myocardial infarction
K Kobayashi1, K Kitamura, N Hirayama
1First Department of Internal Medicine, Miyazaki Medical College, Japan.
Abstract:
Adrenomedullin has a potent vasodilating effect comparable to that of calcitonin gene-related peptide. To investigate the pathophysiologic role of endogenous adrenomedullin, we determined sequentially the plasma adrenomedullin level in 15 consecutive patients with acute myocardial infarction (AMI). Plasma adrenomedullin was higher immediately after the onset of AMI and decreased gradually; plasma levels during the 3-week period after the AMI were higher than plasma levels in 15 healthy control subjects (p < 0.001), with higher levels in patients with congestive heart failure than in patients without congestive heart failure throughout the period of the study (p < 0.05). Plasma adrenomedullin was positively correlated with pulmonary capillary wedge pressure, pulmonary arterial pressure, right atrial pressure, and heart rate in the early stage of AMI. These findings suggest that the elevation of plasma adrenomedullin is related to the retention of body fluid volume, the enhancement of sympathetic activity, and/or the elevation of pressure in pulmonary vascular beds. Adrenomedullin may act against excessive vasoconstrictors increased in AMI.
Insights
Plasma adrenomedullin levels increase significantly after acute myocardial infarction (AMI), correlating with heart failure and elevated pulmonary pressures. This suggests adrenomedullin plays a protective role in AMI patients.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Neuropeptides
Background:
- Adrenomedullin is a peptide hormone with potent vasodilatory properties.
- Its role in acute myocardial infarction (AMI) and associated complications requires further elucidation.
Purpose of the Study:
- To investigate the pathophysiologic role of endogenous adrenomedullin in patients with AMI.
- To determine sequential plasma adrenomedullin levels following AMI onset.
Main Methods:
- Sequential plasma adrenomedullin levels were measured in 15 consecutive AMI patients.
- Plasma levels were compared to 15 healthy control subjects.
- Correlations with hemodynamic parameters were analyzed.
Main Results:
- Plasma adrenomedullin was elevated immediately after AMI onset, gradually decreasing over 3 weeks.
- AMI patients exhibited higher plasma adrenomedullin than controls (p < 0.001).
- Elevated levels were observed in patients with congestive heart failure (p < 0.05) and correlated with pulmonary capillary wedge pressure, pulmonary arterial pressure, right atrial pressure, and heart rate.
Conclusions:
- Elevated plasma adrenomedullin in AMI is linked to fluid volume retention, sympathetic activity, and increased pulmonary vascular pressures.
- Adrenomedullin may counteract excessive vasoconstriction during AMI.