2nd Department of Cardiology, Upper Silesian Medical Center, Katowice, Poland.
Braz J Cardiovasc Surg. 2022 May 2;37(2):219-226. doi: 10.21470/1678-9741-2020-0616.
A potentially new marker of cardiovascular diseases - proadrenomedullin is the precursor of adrenomedullin, which is a multifunctional peptide hormone, produced in most of the tissues in response to cellular stress, ischemia, and hypoxia.
Ninety-three people, aged 51-79 years, were included in the study. Exclusion criteria were severe or corrected valvular disease, acute coronary syndrome, age ≥ 80 years, glomerular filtration rate < 45 ml/min, active infectious diseases, and cancer. The subjects were observed for adverse events, including reduced left ventricular ejection fraction (LVEF) by ≥ 10%, first incidence of atrial fibrillation (AF), and the necessity of using dopamine during hospitalization.
Use of pressure amines, occurrence of the first AF episode, and left ventricular dysfunction defined by a decrease in LVEF by at least 10% compared to the value before surgery were reported in the perioperative period. No death, sudden cardiac arrest with effective resuscitation, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction, or heart failure were observed. Significantly higher proadrenomedullin concentration was observed in the group with reduced postoperative LVEF (1.68 vs. 0.77 nmol/l, P=0.005). The relative risk of a decrease in ejection fraction in the group of patients with proadrenomedullin concentration ≥ 0.77 nmol/l was more than twelve-fold higher (95% confidence interval 1.69-888.33; P=0.013) than in the group of patients with a concentration of proadrenomedullin < 0.77 nmol/l.
The higher baseline concentration of proadrenomedullin has a predominantly predictive value of postoperative left ventricular systolic dysfunction.
作为心血管疾病的一种潜在新标志物，前肾上腺髓质素是肾上腺髓质素的前体，肾上腺髓质素是一种多功能肽类激素，在大多数组织中产生，以响应细胞应激、缺血和缺氧。
本研究纳入了 93 名年龄在 51-79 岁的患者。排除标准为严重或矫正性瓣膜疾病、急性冠状动脉综合征、年龄≥80 岁、肾小球滤过率<45ml/min、活动性传染病和癌症。观察了这些患者的不良事件，包括左心室射血分数（LVEF）降低≥10%、首次发生心房颤动（AF）以及住院期间需要使用多巴胺。
在围手术期报告了使用升压胺、首次发生 AF 发作以及左心室功能障碍（与术前相比 LVEF 至少降低 10%）。未观察到死亡、心脏骤停伴有效复苏、非 ST 段抬高型心肌梗死、ST 段抬高型心肌梗死或心力衰竭。与术后 LVEF 降低组相比，术后 LVEF 降低组的前肾上腺髓质素浓度明显更高（1.68 与 0.77 nmol/l，P=0.005）。在前肾上腺髓质素浓度≥0.77 nmol/l 的患者中，射血分数降低的相对风险高于十二倍（95%置信区间 1.69-888.33；P=0.013），而在前肾上腺髓质素浓度<0.77 nmol/l 的患者中则较低。
较高的基线前肾上腺髓质素浓度对术后左心室收缩功能障碍具有主要的预测价值。
