Plasma adrenomedullin, a new predictor of prognosis and severity in patients with dilated cardiomyopathy and heart failure

ABSTRACT

Adrenomedullin, a potent endogenous vasodilating and natriuretic peptide, may play an important role in the pathophysiology of chronic heart failure associated with dilated cardiomyopathy. To determine the changes of plasma adrenomedullin [AM] in patients with heart failure due to dilated cardiomyopathy of ischemic and idiopathic etiology before and after treatment and the relations between plasma AM and some hormones involved in the pathophysiology of heart failure as plasma renin activity [PRA], atrial natriuretic peptide [ANP] and aldosterone as well as some echocardiographic parameters. Also, the predictive value of AM in assessment of severity of heart failure was evaluated. Design 44 patients with symptomatic dilated cardiomyopathy due to is chemic and idiopathic etiology [24 females and 20 males], aged 53.37 +/- 9.38 years and matched to 13 healthy volunteers [8 females and 5 males] aged 54.3 +/- 8.6 years. Cases were classified according to the New York Heart Association [NYHA] functional classification into 12 cases class 1, 10 cases class 11, 13 cases class III and 9 cases class IV Cases were subjected to thorough history, clinical and laboratory investigations with special stress on plain x-ray chest, ECG, and echocardiography to exclude other etiologies of heart failure. Assay of plasma AM, PRA, ANP and aldosterone was done. Plasma AM, PRA, ANP and aldosterone were significantly higher in patients compared to controls [27.91 +/- 15.19 Vs 11.1 7 +/- 1.55 pmol/L 2.20 +/- 1.48 Vs 0.35 +/- 0.10 ng/L/s; 16.61 +/- 61 Vs 5.57 +/- 1.16fmol/ml, 686.81 +/- 442.78 Vs 176 +/- 18.5 pmol/L respectively] and plasma levels of these hormones increased with the severity of heart failure. There was significant correlation between AM and both PRA, ANP and aldosterone [r=0.650, P<0.001; r=0.612, P<0.001; r=0.677, P<0.001 respectively]. Also there was significant correlation between plasma AM and both ejection fraction [EF] and fractional shortening percentage [FS%] [r=-0.781, P<0.001; r=-863, P<0.001 respectively], Plasma AM decreased in response to treatment of heart failure. Class of heart failure could be predicted in 82.5% of cases by assessment of plasma AM. Plasma AM increases in patients with heart failure due to dilated cardiomyopathy in proportion to the severity of heart failure along with some hormones known to modulate the development of heart failure. AM has a high predictive value in the assessment of the severity of heart failure, Stratification of patients regarding severity of heart failure can be facilitated by plasma AM measurements which could reasonably included in the routine clinical workup of patients with CHF