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European Journal of Heart Failure Advance Access originally published online on February 3, 2009
European Journal of Heart Failure 2009 11(4):361-366; doi:10.1093/eurjhf/hfp004
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Prognostic value of plasma midregional pro-adrenomedullin and C-terminal-pro-endothelin-1 in chronic heart failure outpatients

Christopher Adlbrecht1, Martin Hülsmann1,*, Guido Strunk2, Rudolf Berger1, Deddo Mörtl1, Joachim Struck3, Nils G. Morgenthaler3, Andreas Bergmann3, Johannes Jakowitsch1, Gerald Maurer1, Irene M. Lang1 and Richard Pacher1

1 Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
2 Research Institute for Health Care Management and Economics, Vienna University of Economics and Business Administration, Vienna, Austria
3 B.R.A.H.M.S. AG, Hennigsdorf, Germany

* Corresponding author. Tel: +43 1 40 400 4614, Fax: +43 1 40 400 4216, Email: martin.huelsmann{at}meduniwien.ac.at


  Abstract

Aims: The identification of chronic heart failure (CHF) patients at high risk of adverse outcome remains a challenge. New peptides are emerging that may give additional information. In CHF patients, endothelin (ET) levels predict mortality risk. Adrenomedullin has been shown to predict mortality in ischaemic heart failure, but not in unselected or non-ischaemic CHF patients. Moreover, ADM and ET have never been assessed in one model. The aim of the present study was to assess the prognostic value of midregional-pro-adrenomedullin (MR-proADM) and C-terminal-pro-endothelin-1 (CT-proET-1) in outpatients with CHF.

Methods and results: We measured plasma MR-proADM and CT-proET-1 levels in 786 consecutive CHF outpatients and compared them with B-type natriuretic peptide (BNP) levels. At 24-month follow-up, 233 patients had died. A stepwise forward Cox regression model with age, sex, estimated glomerular filtration rate, NYHA > II, left ventricular ejection fraction (LVEF), MR-proADM, CT-proET-1, and BNP as possible predictors revealed that MR-proADM levels [hazard ratio (HR) = 1.77, P < 0.001] in addition to age (HR = 1.02, P = 0.004), ejection fraction (HR = 0.98, P = 0.004), and NYHA > II (HR = 1.86, P < 0.001) were predictors of death at 24 months. When the analysis was repeated dependent on NYHA-stage, MR-proADM (HR = 2.12, P < 0.001) and LVEF (HR = 0.96, P = 0.006) were significant markers, but only in patients with mild/moderate CHF.

Conclusion: Our data suggest that MR-proADM may be an important prognostic humoral marker, especially in mild/moderately symptomatic and non-ischaemic CHF patients.

Key Words: Adrenomedullin • Endothelin • Heart failure • Prognosis • Mortality • NYHA

Received June 20, 2008; Revised November 14, 2008; Accepted December 5, 2008


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