Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.
Department of Medicine I, Cardiology, University Hospital Würzburg, Würzburg, Germany.
Eur J Heart Fail. 2017 Sep;19(9):1166-1175. doi: 10.1002/ejhf.859. Epub 2017 May 17.
Whereas guidelines recommend the routine use of natriuretic peptides (NPs) in heart failure (HF) care, the clinical relevance and prognostic potential of midregional pro-adrenomedullin (MR-proADM) is less well established. We aimed to compare the prognostic potential of MR-proADM after acute decompensation for systolic HF with that of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and midregional pro-atrial NP (MR-proANP), to investigate the significance of high/rising MR-proADM, and to evaluate the incremental prognostic yield of repeat measurements.
The Interdisciplinary Network Heart Failure (INH) programme enrolled patients hospitalized for acute systolic HF and followed them for 18 months (100% complete). Of 1022 INH participants, 917 (68 ± 12 years, 28% female) who had biomaterials available were enrolled. High MR-proADM was associated with more impaired left ventricular function, higher comorbidity burden, lower doses of HF medications, and lower likelihood of left ventricular reverse remodelling. Compared with NPs, MR-proADM had superior prognostic significance (concordance index 0.72 for all-cause mortality), improved Cox regression models including NPs (P < 0.001), and was the only biomarker also predicting non-cardiac death (hazard ratio 1.8 vs. 1.0). In the setting of low NPs, patients with high MR-proADM experienced non-cardiac death more often. Six month MR-proADM enhanced models including baseline MR-proADM (P < 0.001) for prediction of all-cause death (net reclassification index: 0.48, 95% confidence interval 0.19-0.78).
MR-proADM was found to correlate with the global disease burden in HF and proved a potent prognostic indicator, capturing the risk for both cardiac and non-cardiac death. Serial MR-proADM measurements further enhanced risk assessment, thus facilitating substantial reclassification.
虽然指南建议在心力衰竭（HF）治疗中常规使用利钠肽（NPs），但 midregional pro-adrenomedullin（MR-proADM）的临床相关性和预后潜力尚未得到充分证实。我们旨在比较急性失代偿性收缩性 HF 后 MR-proADM 的预后潜力与 N 末端 pro-B 型利钠肽（NT-proBNP）和 midregional pro-atrial NP（MR-proANP）的预后潜力，探讨高/升高的 MR-proADM 的意义，并评估重复测量的增量预后价值。
多学科网络心力衰竭（INH）计划纳入了因急性收缩性 HF 住院的患者，并对其进行了 18 个月的随访（100%完整）。在 1022 名 INH 参与者中，有 917 名（68±12 岁，28%为女性）有生物材料可用，被纳入研究。高 MR-proADM 与更严重的左心室功能障碍、更高的合并症负担、更低剂量的 HF 药物以及更低的左心室逆重构可能性相关。与 NPs 相比，MR-proADM 具有更好的预后意义（全因死亡率的一致性指数为 0.72），改善了包括 NPs 在内的 Cox 回归模型（P<0.001），并且是唯一预测非心脏死亡的生物标志物（危险比 1.8 与 1.0）。在 NPs 水平较低的情况下，MR-proADM 水平较高的患者更常发生非心脏死亡。6 个月时的 MR-proADM 增强了包括基线时 MR-proADM 在内的模型（P<0.001），用于预测全因死亡（净重新分类指数：0.48，95%置信区间 0.19-0.78）。
MR-proADM 与 HF 中的整体疾病负担相关，证明是一种有效的预后指标，可捕捉心脏和非心脏死亡的风险。连续测量 MR-proADM 可进一步提高风险评估，从而实现大量重新分类。
