Medical University of Vienna, Department of Medicine II, Division of Cardiology, Austria.
Departments of Medicine, Clinical Pharmacology, Pharmacology, and Neurology, Vanderbilt Autonomic Dysfunction Center, Nashville, TN, United States.
Clin Biochem. 2020 Sep;83:37-42. doi: 10.1016/j.clinbiochem.2020.05.016. Epub 2020 Jun 4.
Elevated plasma levels of asymmetric dimethylarginine (ADMA), an inhibitor of NO synthase, are associated with adverse outcome. There is no data available, whether ADMA levels are associated with arrhythmic death (AD) in patients with ischemic cardiomyopathy (ICM) or non-ischemic, dilated cardiomyopathy (DCM).
A total of 110 ICM, 52 DCM and 30 control patients were included. Primary outcome parameter of this prospective study was arrhythmic death (AD) or resuscitated cardiac arrest (RCA). Plasma levels of ADMA were significantly higher in ICM (p < 0.001) and in DCM (p < 0.001) patients compared to controls. During a median follow-up of 7.0 years, 62 (32.3%) patients died. AD occurred in 26 patients and RCA was observed in 22 patients. Plasma levels of ADMA were not associated with a significantly increased risk of AD or RCA in ICM (hazard ratio (HR) = 1.37, p = 0.109) or in DCM (HR = 1.06, p = 0.848) patients. No significant association was found with overall mortality in ICM (HR = 1.39, p = 0.079) or DCM (HR = 1.10, p = 0.666) patients. Stratified Kaplan-Meier curves for ADMA levels in the upper tertile (>0.715 µmol/l) or the two lower tertiles (≤0.715 µmol/l) did not show a higher risk for AD or RCA (p = 0.221) or overall mortality (p = 0.548). In patients with left ventricular ejection fraction ≤ 35%, ADMA was not associated with AD or RCA (HR = 1.35, p = 0.084) or with overall mortality (HR = 1.24, p = 0.162).
Plasma levels of ADMA were elevated in patients with ICM or DCM as compared to controls, but were not significantly predictive for overall mortality or the risk for arrhythmic death.
不对称二甲基精氨酸（ADMA）是一氧化氮合酶的抑制剂，其血浆水平升高与不良预后相关。然而，ADMA 水平是否与缺血性心肌病（ICM）或非缺血性、扩张型心肌病（DCM）患者的心律失常性死亡（AD）相关，目前尚无相关数据。
共纳入 110 例 ICM 患者、52 例 DCM 患者和 30 例对照组患者。本前瞻性研究的主要终点参数为心律失常性死亡（AD）或复苏性心脏骤停（RCA）。与对照组相比，ICM（p<0.001）和 DCM（p<0.001）患者的 ADMA 血浆水平显著升高。在中位随访 7.0 年期间，有 62 名（32.3%）患者死亡。26 名患者发生 AD，22 名患者发生 RCA。ADMA 血浆水平与 ICM（危险比（HR）=1.37，p=0.109）或 DCM（HR=1.06，p=0.848）患者 AD 或 RCA 风险的显著增加无关。在 ICM（HR=1.39，p=0.079）或 DCM（HR=1.10，p=0.666）患者中，也未发现与总死亡率之间存在显著关联。在 ADMA 水平处于上 3 分位数（>0.715µmol/L）或两个下 3 分位数（≤0.715µmol/L）的患者中，分层的 Kaplan-Meier 曲线并未显示 AD 或 RCA（p=0.221）或总死亡率（p=0.548）的风险更高。在左心室射血分数≤35%的患者中，ADMA 与 AD 或 RCA（HR=1.35，p=0.084）或总死亡率（HR=1.24，p=0.162）无关。
与对照组相比，ICM 或 DCM 患者的 ADMA 血浆水平升高，但对总死亡率或心律失常性死亡风险无显著预测作用。
