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Lammert J, Basrai M, Struck J, Hartmann O, Engel C, Bischoff SC, Berling-Ernst A, Halle M, Kiechle M, Grill S. Associations of Plasma Bioactive Adrenomedullin Levels with Cardiovascular Risk Factors in BRCA1/2 Mutation Carriers. Geburtshilfe Frauenheilkd 2022; 82:601-609. [PMID: 35903716 PMCID: PMC9315398 DOI: 10.1055/a-1811-2164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Cardiovascular disease (CVD) is an important cause of morbidity and mortality in breast cancer survivors. Effective screening modalities to identify CVD risk are lacking
in this population. Adrenomedullin (ADM) has been suggested as a biomarker for subclinical cardiac dysfunction in the general population. Levels of ADM have been proven to be responsive to
lifestyle changes that lead to improved cardiovascular health. As
BRCA1/2
mutation carriers are deemed to be at an increased risk for CVD, the aim of this study was to examine plasma
ADM levels in a cohort of
BRCA
mutation carriers and to assess their association with cardiovascular risk factors.
Methods
Plasma ADM concentrations were measured in 292 female
BRCA1/2
mutation carriers with and without a history of breast cancer. Subjects were classified into high versus
low ADM levels based on the median ADM level in the entire cohort (13.8 pg/mL). Logistic regression models were used to estimate the odds ratios (OR) of having elevated ADM levels by several
cardiovascular risk factors.
Results
Of all women (median age: 43 years), 57.5% had a previous diagnosis of breast cancer. The median time between diagnosis and study entry was three years (range: 0 – 32 years).
Women presenting with metabolic syndrome had 22-fold increased odds of having elevated ADM levels (p < 0.001). Elevated ADM levels were associated with lower cardiorespiratory fitness
(OR = 0.88, p < 0.001) and several parameters of obesity (p < 0.001). ADM levels were higher in women who have ever smoked (OR = 1.72, p = 0.02). ADM levels were not associated with a
previous diagnosis of breast cancer (p = 0.28).
Conclusions
This is the first study in
BRCA
mutation carriers that has linked circulating ADM levels to traditional cardiovascular risk factors. The long-term clinical
implications of these findings are yet to be determined.
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Affiliation(s)
- Jacqueline Lammert
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, University Hospital rechts der Isar, Technical University of Munich (TUM), Munich,
Germany
| | - Maryam Basrai
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | | | | | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Stephan C. Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Anika Berling-Ernst
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, University Hospital rechts der Isar, Technical University of Munich (TUM), Munich,
Germany
| | - Sabine Grill
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, University Hospital rechts der Isar, Technical University of Munich (TUM), Munich,
Germany
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Gracia Arnillas MP, Alvarez-Lerma F, Masclans JR, Roquer J, Soriano C, Manzano D, Zapatero A, Diaz Y, Duran X, Castellví A, Cuadrado E, Ois A. Impact of adrenomedullin levels on clinical risk stratification and outcome in subarachnoid haemorrhage. Eur J Clin Invest 2020; 50:e13318. [PMID: 32535893 DOI: 10.1111/eci.13318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To use classification tree analysis to identify risk factors for nonsurvival in a neurological patients with subarachnoid haemorrhage (SAH) and to propose a clinical model for predicting of mortality. METHODS Prospective study of SAH admitted to a Critical Care Department and Stroke Unit over a 2-year period. Middle region of pro-ADM plasma levels (MR-proADM) was measured in EDTA plasma within the first 24 hours of hospital admission using the automatic immunofluorescence test. A regression tree was made to identify prognostic models for the development of mortality at 90 days. RESULTS Ninety patients were included. The mean MR-proADM plasma value in the samples analysed was 0.78 ± 0.41 nmol/L. MR-proADM plasma levels were significantly associated with mortality at 90 days (1.05 ± 0.51 nmol/L vs 0.64 ± 0.25 nmol/L; P < .001). Regression tree analysis provided an algorithm based on the combined use of clinical variables and one biomarker allowing accurate mortality discrimination of three distinct subgroups with high risk of 90-day mortality ranged from 75% to 100% (AUC 0.9; 95% CI 0.83-0.98). CONCLUSIONS The study established a model (APACHE II, MR-proADM and Hunt&Hess) to predict fatal outcomes in patients with SAH. The proposed decision-making algorithm may help identify patients with a high risk of mortality.
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Affiliation(s)
- Maria Pilar Gracia Arnillas
- Critical Care Department, IMIM- Hospital del Mar, Barcelona, Spain.,IMIM (Medical Research Mar Institute), IMIM- Hospital del Mar, Barcelona, Spain
| | - Francisco Alvarez-Lerma
- Critical Care Department, IMIM- Hospital del Mar, Barcelona, Spain.,IMIM (Medical Research Mar Institute), IMIM- Hospital del Mar, Barcelona, Spain
| | - Jose-Ramón Masclans
- Critical Care Department, IMIM- Hospital del Mar, Barcelona, Spain.,IMIM (Medical Research Mar Institute), IMIM- Hospital del Mar, Barcelona, Spain
| | - Jaume Roquer
- Department of Neurology, Neurovascular Research Group, IMIM- Hospital del Mar, Barcelona, Spain
| | - Carolina Soriano
- IMIM (Medical Research Mar Institute), IMIM- Hospital del Mar, Barcelona, Spain
| | - Demian Manzano
- Neurosurgery Department, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
| | - Ans Zapatero
- Critical Care Department, IMIM- Hospital del Mar, Barcelona, Spain.,IMIM (Medical Research Mar Institute), IMIM- Hospital del Mar, Barcelona, Spain
| | - Yolanda Diaz
- Critical Care Department, IMIM- Hospital del Mar, Barcelona, Spain.,IMIM (Medical Research Mar Institute), IMIM- Hospital del Mar, Barcelona, Spain
| | - Xavi Duran
- AMIB Methodological and Biostatistical Advice IMIM, IMIM- Hospital del Mar, Barcelona, Spain
| | - Andrea Castellví
- Critical Care Department, IMIM- Hospital del Mar, Barcelona, Spain
| | - Elisa Cuadrado
- Department of Neurology, Neurovascular Research Group, IMIM- Hospital del Mar, Barcelona, Spain
| | - Angel Ois
- Department of Neurology, Neurovascular Research Group, IMIM- Hospital del Mar, Barcelona, Spain
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Schuetz P, Marlowe RJ, Mueller B. The prognostic blood biomarker proadrenomedullin for outcome prediction in patients with chronic obstructive pulmonary disease (COPD): a qualitative clinical review. Clin Chem Lab Med 2015; 53:521-39. [PMID: 25252756 DOI: 10.1515/cclm-2014-0748] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 08/24/2014] [Indexed: 01/29/2023]
Abstract
Plasma proadrenomedullin (ProADM) is a blood biomarker that may aid in multidimensional risk assessment of patients with chronic obstructive pulmonary disease (COPD). Co-secreted 1:1 with adrenomedullin (ADM), ProADM is a less biologically active, more chemically stable surrogate for this pluripotent regulatory peptide, which due to biological and ex vivo physical characteristics is difficult to reliably directly quantify. Upregulated by hypoxia, inflammatory cytokines, bacterial products, and shear stress and expressed widely in pulmonary cells and ubiquitously throughout the body, ADM exerts or mediates vasodilatory, natriuretic, diuretic, antioxidative, anti-inflammatory, antimicrobial, and metabolic effects. Observational data from four separate studies totaling 1366 patients suggest that as a single factor, ProADM is a significant independent, and accurate, long-term all-cause mortality predictor in COPD. This body of work also suggests that combined with different groups of demographic/clinical variables, ProADM provides significant incremental long-term mortality prediction power relative to the groups of variables alone. Additionally, the literature contains indications that ProADM may be a global cardiopulmonary stress marker, potentially supplying prognostic information when cardiopulmonary exercise testing results such as 6-min walk distance are unavailable due to time or other resource constraints or to a patient's advanced disease. Prospective, randomized, controlled interventional studies are needed to demonstrate whether ProADM use in risk-based guidance of site-of-care, monitoring, and treatment decisions improves clinical, quality-of-life, or pharmacoeconomic outcomes in patients with COPD.
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4
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Adaptive cardiovascular hormones in a spectrum of heart failure phenotypes. Int J Cardiol 2015; 189:6-11. [DOI: 10.1016/j.ijcard.2015.03.381] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/06/2015] [Accepted: 03/25/2015] [Indexed: 01/09/2023]
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5
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Zoller B, Spanaus K, Gerster R, Fasshauer M, Stehberger PA, Klinzing S, Vergopoulos A, von Eckardstein A, Béchir M. ICG-liver test versus new biomarkers as prognostic markers for prolonged length of stay in critically ill patients - a prospective study of accuracy for prediction of length of stay in the ICU. Ann Intensive Care 2014; 4:19. [PMID: 25045579 PMCID: PMC4100565 DOI: 10.1186/s13613-014-0019-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 05/22/2014] [Indexed: 12/05/2022] Open
Abstract
Background Prognostic abilities of medical parameters, which are scoring systems, measurements and biomarkers, are important for stratifying critically ill patients. Indocyanine green plasma disappearance (ICG-PDR) is an established clinical tool for the assessment of liver perfusion and function. Copeptin, MR-proANP and pro-ADM are biomarkers whose prognostic value is still unclear. The goal of this prospective study was to evaluate ICG-PDR, copeptin, MR-proANP and pro-ADM to predict prolonged length of stay (pLOS) in the ICU. Methods This study was conducted as a prospective single center study including 110 consecutively admitted ICU patients. Primary endpoint was prolonged length of stay (pLOS) in the ICU, defined as more than three days of stay there. Results ROC analysis showed an AUC of 0.73 for ICG-PDR, 0.70 for SAPS II, 0.65 for MR-proANP, 0.64 for pro-ADM and 0.54 for copeptin for pLOS in the ICU. Conclusions The prediction of pLOS in the ICU might be better by means of ICG-PDR than with the new biomarkers copeptin, MR-proANP or pro-ADM. Nevertheless, there is more need for research to evaluate whether ICG-PDR is an overall prognostic marker for pLOS. Trial registration (ClinicalTrials.gov number, NCT01126554).
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Affiliation(s)
- Bernhard Zoller
- Surgical Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Katharina Spanaus
- Institute of Clinical Chemistry, University and University Hospital Zurich, Zurich, Switzerland
| | - Rahel Gerster
- Surgical Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Mario Fasshauer
- Surgical Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Paul A Stehberger
- Surgical Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Stephanie Klinzing
- Surgical Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Athanasios Vergopoulos
- Institute of Clinical Chemistry, University and University Hospital Zurich, Zurich, Switzerland
| | - Arnold von Eckardstein
- Institute of Clinical Chemistry, University and University Hospital Zurich, Zurich, Switzerland
| | - Markus Béchir
- Surgical Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland ; Swiss Paraplegic Center, Nottwil, Switzerland
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6
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Tzikas S, Keller T, Wild PS, Schulz A, Zwiener I, Zeller T, Schnabel RB, Sinning C, Lubos E, Kunde J, Münzel T, Lackner KJ, Blankenberg S. Midregional pro-atrial natriuretic peptide in the general population/Insights from the Gutenberg Health Study. Clin Chem Lab Med 2014. [PMID: 23183754 DOI: 10.1515/cclm-2012-0541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of biomarkers is firmly established for the assessment of cardiovascular disease. Emerging biomarkers such as midregional pro-atrial natriuretic peptide (MR-proANP) challenge established markers regarding risk prediction and stratification ability. The aim of the present study was to describe the distribution of a contemporary MR-proANP assay in a large population-representative sample and to evaluate the association with prevalent cardiac diseases and cardiovascular risk factors. METHODS MR-proANP was determined by the use of a contemporary commercially available assay (BRAHMS GmbH, Hennigsdorf, Germany) in a representative sample of 5000 participants from the large population-based Gutenberg Health Study. N-terminal pro B-type natriuretic peptide (NT-proBNP) was used as a comparator. RESULTS Mean age was 55.5 ± 10.9 years. Coronary artery disease (CAD) was documented in 4.6%, heart failure (HF) in 1.5% of the study participants. We observed a moderate to strong correlation of the biomarkers with age, diabetes, hypertension, smoking, renal function, prevalence of CAD and HF. Males showed lower MR-proANP concentrations than females. MR-proANP showed no relevant correlation with BMI (ρ=-0.030) and CRP (ρ=0.039). Reference limits for MR-proANP representing the 95th/97.5th/99th percentile were determined for healthy individuals with 116/132/169 pmol/mL. CONCLUSIONS The current analysis in a large population-based sample elucidates the correlations and distribution of MR-proANP. Its concentration in healthy individuals depends on prevalent cardiovascular diseases and classical risk factors. The reported population-based reference values might be useful for distinguishing between healthy and diseased individuals, thus improving risk stratification and triaging in various clinical settings.
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Affiliation(s)
- Stergios Tzikas
- Department of Medicine 2, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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7
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Grange RD, Thompson JP, Lambert DG. Radioimmunoassay, enzyme and non-enzyme-based immunoassays. Br J Anaesth 2014; 112:213-6. [PMID: 24431350 DOI: 10.1093/bja/aet293] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- R D Grange
- Department of Cardiovascular Sciences, Division of Anaesthesia, Critical Care and Pain Management, Leicester Royal Infirmary, University of Leicester, Leicester, UK
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8
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Funke-Kaiser A, Mann K, Colquhoun D, Zeller T, Hunt D, Simes J, Sullivan D, Sydow K, West M, White H, Blankenberg S, Tonkin AM. Midregional proadrenomedullin and its change predicts recurrent major coronary events and heart failure in stable coronary heart disease patients: the LIPID study. Int J Cardiol 2014; 172:411-8. [PMID: 24508492 DOI: 10.1016/j.ijcard.2014.01.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/15/2014] [Accepted: 01/18/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Biomarkers may contribute to risk stratification in coronary heart disease (CHD). We examined whether plasma midregional proadrenomedullin (MR-proADM) concentration at baseline and its change over one year predicts long-term outcomes in stable CHD patients. METHODS The LIPID study randomised patients 3-36 months after an acute coronary syndrome with total cholesterol 4.0-7.0 mmol/L (155-271 mg/dL), to placebo or pravastatin 40 mg. Follow-up was 6.0 years. MR-proADM plasma concentrations at baseline and one year later were determined in 7863 and 6658 patients, respectively. These were categorised into quartiles to perform Cox regression analysis, adjusting for baseline parameters. RESULTS Baseline MR-proADM concentrations predicted major CHD events (non-fatal myocardial infarction or CHD death; hazard ratio (HR) 1.52, 1.26-1.84 for Q4-Q1), CHD death (HR 2.21, 1.67-2.92), heart failure (HR 2.30, 1.78-2.97) and all-cause mortality (HR 1.82, 1.49-2.23). Associations were still significant after adjustment for baseline B-type natriuretic peptide (BNP) concentration. Increase in MR-proADM after one year was associated with increased risk of subsequent CHD events (HR 1.34, 1.08-1.66), non-fatal myocardial infarction (HR 1.50, 1.12-2.03), heart failure (HR 1.78, 1.37-2.30) and all-cause mortality (HR 1.31, 1.04-1.64). Associations with heart failure and all-cause mortality remained significant after adjusting for baseline and change in BNP concentration. Change in MR-proADM moderately improved risk reclassification for major CHD events (net reclassification improvement (NRI) 3.48%) but strongly improved risk reclassification for heart failure (NRI 5.60%). CONCLUSIONS Baseline and change in MR-proADM concentrations over one year are associated with risk of major clinical events, even after adjustment for BNP concentrations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Harvey White
- Green Lane Cardiovascular Service, Auckland, New Zealand
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9
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Associations of mid-regional pro-adrenomedullin levels to cardiovascular and metabolic abnormalities, and mortality in an elderly population from the community. Int J Cardiol 2013; 168:3537-42. [DOI: 10.1016/j.ijcard.2013.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 03/29/2013] [Accepted: 05/03/2013] [Indexed: 11/23/2022]
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10
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Wong HK, Ong KL, Leung RYH, Lam TH, Thomas GN, Lam KSL, Cheung BMY. A single nucleotide polymorphism of interleukin-6 gene is related to plasma adrenomedullin levels. Clin Endocrinol (Oxf) 2013; 79:504-9. [PMID: 23088295 DOI: 10.1111/cen.12078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 08/23/2012] [Accepted: 10/15/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Elevated plasma adrenomedullin (ADM) levels are associated with cardiovascular diseases. Single nucleotide polymorphisms (SNPs) in the gene encoding ADM (ADM) are associated with plasma ADM levels. The presence of a nuclear factor for interleukin-6 (IL-6) expression binding site in the promoter region of the ADM gene suggests a possible relationship between the expression of the ADM and IL-6. Therefore, we investigated whether plasma ADM levels are related to SNPs in the gene encoding IL-6 (IL6). METHODS Plasma ADM levels were measured in 476 subjects in the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS2). The subjects were genotyped for three tagging SNPs in the IL6 gene. RESULTS The minor allele frequencies of the IL6 SNPs rs17147230, rs1800796 and rs2069837 were 41·8%, 20·0% and 15·4%, respectively. The tagging SNP, rs17147230, was associated with plasma ADM levels after adjusting for age and sex (β=-0·096, P = 0·034). The association was significant in women (β=-0·115, P = 0·021) but not in men. Among all subjects, plasma ADM levels decreased with an increasing number of minor alleles of rs17147230 in multivariate analysis (P = 0·034). Compared to subjects with the AA genotype, subjects with the TT genotype had plasma ADM levels 12·8% lower (95% CI: 0·6-23·5%, P = 0·041). Haplotype analysis demonstrated a significant association of the haplotype ACA with plasma ADM levels in women (P < 0·05). CONCLUSION Plasma ADM levels are related to the SNP rs17147230 in IL6 gene. The effect of the polymorphism on inflammation and cardiovascular disease remains to be determined.
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Affiliation(s)
- Hoi Kin Wong
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
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11
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Christensen HM, Schou M, Goetze JP, Faber J, Frystyk J, Flyvbjerg A, Kistorp C. Body mass index in chronic heart failure: association with biomarkers of neurohormonal activation, inflammation and endothelial dysfunction. BMC Cardiovasc Disord 2013; 13:80. [PMID: 24083942 PMCID: PMC3850723 DOI: 10.1186/1471-2261-13-80] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low body mass index (BMI) is associated with a poor outcome in chronic heart failure (CHF). An inverse association between BMI and adiponectin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been reported. The aim of the present study was to investigate whether novel markers of neurohormonal activation, inflammation, and endothelial dysfunction are associated with BMI in CHF. METHODS In a cross-sectional study including 171 patients with CHF and a left ventricular ejection fraction (LVEF) ≤45% the impact of BMI on circulating plasma concentrations of adiponectin, α-defensins, high sensitivity C-reactive protein (hsCRP), copeptin, mid-regional pro-adrenomedullin (MR-proADM), NT-proBNP, and mid-regional pro-A-type natriuretic peptide (MR-proANP) were evaluated. RESULTS In multivariable linear regression analysis including age, sex, LVEF, New York Heart Association functional classification (NYHA), estimated glomerular filtration rate (eGFR), and diabetes, only NT-proBNP (β = -0.32) and adiponectin (β = -0.39) remained independently associated with BMI. MR-proANP was associated with BMI but adjusting for age attenuated the relation being no longer significant. CONCLUSIONS Among biomarkers typically increased in patients with CHF only adiponectin and NT-proBNP demonstrated independent inverse associations with BMI. This indicates a direct effect of these two biomarkers enhancing the wasting process seen in CHF.
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Affiliation(s)
- Heidi M Christensen
- Departments of Cardiology and Endocrinology, Herlev University Hospital, Ringvej 75, Herlev 2730, Denmark.
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12
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Neumann JT, Tzikas S, Funke-Kaiser A, Wilde S, Appelbaum S, Keller T, Ojeda-Echevarria F, Zeller T, Zwiener I, Sinning CR, Jagodzinski A, Schnabel RB, Lackner KJ, Münzel T, Blankenberg S, Wild PS, Sydow K. Association of MR-proadrenomedullin with cardiovascular risk factors and subclinical cardiovascular disease. Atherosclerosis 2013; 228:451-9. [PMID: 23562132 DOI: 10.1016/j.atherosclerosis.2013.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/20/2013] [Accepted: 03/03/2013] [Indexed: 02/06/2023]
Abstract
AIMS AND BACKGROUND Midregional proadrenomedullin (MR-proADM) is a protein, which exerts various effects on the cardiovascular system. Recent studies underscored its prognostic implications in patients with acute dyspnea and cardiovascular diseases. Therefore, we aimed to determine the distribution of MR-proADM in the general population and to reveal potential associations of MR-proADM with cardiovascular risk factors and measures of subclinical cardiovascular disease. METHODS AND RESULTS MR-proADM plasma concentrations were determined in individuals of the population-based cohort of the Gutenberg Health Study (N = 5000) using a commercially available fluoroimmunoassay. Individuals were enrolled between April 2007 and October 2008. Subclinical cardiovascular disease was assessed using echocardiographic and functional measures of myocardial and vascular function. The mean age of the study population was 55.5 ± 10.9 years. In the overall population we determined a median MR-proADM plasma concentration of 0.44 nmol/L in men and women. MR-proADM concentrations were elevated in individuals with hypertension, diabetes, dyslipidemia, known cardiovascular disease, heart failure, peripheral artery disease, atrial fibrillation, and history of myocardial infarction and stroke. In men, we observed a positive association of MR-proADM with reduced ejection fraction, intraventricular septal diameter, wall thickness, and echocardiographic measures of diastolic dysfunction. CONCLUSIONS In this study, we present age-dependent reference values for MR-proADM in a representative population sample. Elevated MR-proADM plasma concentrations were strongly associated with classical cardiovascular risk factors and manifest cardiovascular diseases. Furthermore, we revealed a gender-specific association with echocardiographic measures of hypertension. MR-proADM seems to be a promising prognostic biomarker for subclinical and manifest cardiovascular disease.
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Affiliation(s)
- Johannes Tobias Neumann
- Department of General and Interventional Cardiology, Hamburg University Heart Center, Martinistraße 52, 20246 Hamburg, Germany
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13
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Hiltunen M, Kerola T, Kettunen R, Hartikainen S, Sulkava R, Vuolteenaho O, Nieminen T. The prognostic capacity of B-type natriuretic peptide on cognitive disorder varies by age. Ann Med 2013; 45:74-8. [PMID: 22680229 DOI: 10.3109/07853890.2012.663929] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION It is known that blood levels of natriuretic peptides associate with cognitive disorder among the middle-aged. We aimed to test whether this association is valid in an older population aged 75 years or older. METHODS A total of 601 older subjects aged 75 or older participated in the study. A subgroup of 137 with a diagnosed cognitive disorder were tested for natriuretic peptides (ANP, NT-proANP, and BNP), and compared with age-matched controls (n = 464). The control group was followed-up for 5 years, and the association of the baseline BNP with the occurrence of cognitive impairment was studied. RESULTS In the youngest age tertile (75-78 y), BNP was significantly associated with a diagnosed cognitive disorder when other factors with a known effect on natriuretic peptides were taken into account. In the oldest tertile (83-96 y), higher BNP values suggested the absence of cognitive dysfunction. ANP and NT-proANP did not associate with the presence of cognitive impairment. Among the control group, BNP predicted a cognitive disorder at follow-up, but only in the youngest tertile. CONCLUSIONS The previously found link between a high BNP concentration and cognitive disorder in older people is only valid among those aged less than 79 years.
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Affiliation(s)
- Matti Hiltunen
- Department of Clinical Neurophysiology, Helsinki University Central Hospital, FI-00290 Helsinki, Finland
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14
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Potocki M, Ziller R, Mueller C. Mid-Regional Pro-Adrenomedullin in Acute Heart Failure: A Better Biomarker or Just Another Biomarker? Curr Heart Fail Rep 2012; 9:244-51. [DOI: 10.1007/s11897-012-0096-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Daniels LB, Clopton P, Potocki M, Mueller C, McCord J, Richards M, Hartmann O, Anand IS, Wu AHB, Nowak R, Peacock WF, Ponikowski P, Mockel M, Hogan C, Filippatos GS, Di Somma S, Ng L, Neath SX, Christenson R, Morgenthaler NG, Anker SD, Maisel AS. Influence of age, race, sex, and body mass index on interpretation of midregional pro atrial natriuretic peptide for the diagnosis of acute heart failure: results from the BACH multinational study. Eur J Heart Fail 2011; 14:22-31. [PMID: 22140234 DOI: 10.1093/eurjhf/hfr157] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Midregional pro atrial natriuretic peptide (MR-proANP) is useful for diagnosing acute heart failure (HF) in patients presenting to the Emergency Department with dyspnoea. Optimal interpretation of MR-proANP requires understanding of how various demographic variables influence its levels and performance as a diagnostic marker. We sought to determine how age, race, sex, and body mass index (BMI) affect the levels and interpretation of MR-proANP for the diagnosis of acute HF. METHODS AND RESULTS The Biomarkers in Acute Heart Failure (BACH) study was an international 15-centre study of 1641 patients presenting to the Emergency Department with acute dyspnoea. Of these, 1352 had complete information on age, race, sex, and BMI. MR-proANP levels increased with age and were higher in men and in patients with lower BMI. MR-proANP performed better as a diagnostic marker in younger individuals and in blacks compared with whites. Despite this, MR-proANP at the recommended cut-off point of 120 pmol/L was >90 % sensitive in ruling out the diagnosis of acute HF in all subgroups of patients except white subjects <50 years old. CONCLUSION Age, race, sex, and BMI affect MR-proANP levels to various degrees. However, the diagnostic performance of the recommended cut-off point of 120 pmol/L to rule out acute HF was robust across most subgroups. Although both sex and BMI affected MR-proANP levels, they did not alter its overall diagnostic performance. Lower cut-off points for MR-proANP could be considered in younger patients and in patients with a higher BMI, to optimize diagnostic sensitivity.
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