Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France.
Eur J Heart Fail. 2024 Jul;26(7):1480-1492. doi: 10.1002/ejhf.3336. Epub 2024 Jun 14.
Biologically active adrenomedullin (bio-ADM) is a promising marker of residual congestion. The STRONG-HF trial showed that high-intensity care (HIC) of guideline-directed medical therapy (GDMT) improved congestion and clinical outcomes in heart failure (HF) patients. The association between bio-ADM, decongestion, outcomes and the effect size of HIC of GDMT remains to be elucidated.
We measured plasma bio-ADM concentrations in 1005 patients within 2 days prior to anticipated discharge (baseline) and 90 days later. Bio-ADM correlated with most signs of congestion, with the exception of rales. Changes in bio-ADM were strongly correlated with change in congestion status from baseline to day 90 (gamma -0.24; p = 0.0001). Patients in the highest tertile of baseline bio-ADM concentrations were at greater risk than patients in the lowest tertile for the primary outcome of 180-day all-cause mortality or HF rehospitalization (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.42-3.22) and 180-day HF rehospitalization (HR 2.33, 95% CI 1.38-3.94). Areas under the receiver-operating characteristic curves were 0.5977 (95% CI 0.5561-0.6393), 0.5800 (95% CI 0.5356-0.6243), and 0.6159 (95% CI 0.5711-0.6607) for bio-ADM, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and their combination, respectively, suggesting that both bio-ADM and NT-proBNP provided similarly modest discrimination for this outcome. A trend towards better discrimination by combined bio-ADM and NT-proBNP than NT-proBNP alone was found (p = 0.059). HIC improved the primary outcome, irrespective of baseline bio-ADM concentration (interaction p = 0.37). In contrast to NT-proBNP, the 90-day change in bio-ADM did not differ significantly between HIC and usual care.
Bio-ADM is a marker of congestion and predicts congestion at 3 months after a HF hospitalization. Higher bio-ADM was modestly associated with a higher risk of death and early hospital readmission and may have added value when combined with NT-proBNP.
生物活性肾上腺髓质素（bio-ADM）是残留充血的有前途的标志物。STRONG-HF 试验表明，高强度护理（HIC）指导下的医学治疗（GDMT）改善了心力衰竭（HF）患者的充血和临床结局。生物活性 ADM、充血缓解、结局以及 GDMT 的 HIC 的效果大小之间的关联仍有待阐明。
我们在预期出院前 2 天（基线）和 90 天后测量了 1005 名患者的血浆生物活性 ADM 浓度。生物活性 ADM 与充血的大多数迹象相关，除了啰音。从基线到第 90 天，生物活性 ADM 的变化与充血状态的变化呈强相关性（γ-0.24；p=0.0001）。与最低三分位的患者相比，基线生物活性 ADM 浓度最高三分位的患者发生 180 天全因死亡率或 HF 再入院的主要结局的风险更高（风险比 [HR] 2.14，95%置信区间 [CI] 1.42-3.22）和 180 天 HF 再入院（HR 2.33，95%CI 1.38-3.94）。生物活性 ADM、N 末端 pro-B 型利钠肽（NT-proBNP）及其组合的受试者工作特征曲线下面积分别为 0.5977（95%CI 0.5561-0.6393）、0.5800（95%CI 0.5356-0.6243）和 0.6159（95%CI 0.5711-0.6607），表明生物活性 ADM 和 NT-proBNP 对该结局的区分能力相似。发现生物活性 ADM 和 NT-proBNP 联合比 NT-proBNP 单独具有更好的区分趋势（p=0.059）。无论基线生物活性 ADM 浓度如何，HIC 均改善了主要结局（交互作用 p=0.37）。与 NT-proBNP 不同，HIC 和常规护理之间 90 天的生物活性 ADM 变化没有显著差异。
生物活性 ADM 是充血的标志物，并预测 HF 住院后 3 个月的充血情况。较高的生物活性 ADM 与死亡和早期医院再入院的风险较高适度相关，与 NT-proBNP 联合使用可能具有额外的价值。
