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Bioactive adrenomedullin for assessment of venous congestion in heart failure

Egerstedt, Anna LU ; Czuba, Tomasz LU ; Bronton, Kevin LU orcid ; Lejonberg, Carl LU ; Ruge, Thoralph ; Wessman, Torgny LU ; Rådegran, Göran LU ; Schulte, Janin ; Hartmann, Oliver and Melander, Olle LU orcid , et al. (2022) In ESC Heart Failure 9(5). p.3543-3555
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bioactive adrenomedullin, Biomarker, Congestion, Haemodynamics, Heart failure, Prognosis
in
ESC Heart Failure
volume
9
issue
5
pages
3543 - 3555
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:35903845
  • scopus:85135129189
ISSN
2055-5822
DOI
10.1002/ehf2.14018
language
English
LU publication?
yes
id
2b6a3666-ccb9-4352-934c-ead3bb5c052a
date added to LUP
2022-10-28 13:58:27
date last changed
2024-06-13 22:08:02
@article{2b6a3666-ccb9-4352-934c-ead3bb5c052a,
  abstract     = {{<p>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.</p>}},
  author       = {{Egerstedt, Anna and Czuba, Tomasz and Bronton, Kevin and Lejonberg, Carl and Ruge, Thoralph and Wessman, Torgny and Rådegran, Göran and Schulte, Janin and Hartmann, Oliver and Melander, Olle and Smith, J. Gustav}},
  issn         = {{2055-5822}},
  keywords     = {{Bioactive adrenomedullin; Biomarker; Congestion; Haemodynamics; Heart failure; Prognosis}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{3543--3555}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{ESC Heart Failure}},
  title        = {{Bioactive adrenomedullin for assessment of venous congestion in heart failure}},
  url          = {{http://dx.doi.org/10.1002/ehf2.14018}},
  doi          = {{10.1002/ehf2.14018}},
  volume       = {{9}},
  year         = {{2022}},
}