INCREASED PLASMA ADRENOMEDULLIN LEVELS IN CHRONIC CONGESTIVE-HEART-FAILURE

Adrenomedullin is a potent vasodilator peptide and occurs in circulati ng blood of human beings and experimental animals. Because it is produ ced in intact aorta of rats and in cultured vascular endothelial cells , adrenomedullin seems to participate in regulation of local vascular tone. To determine the pathophysiological roles of adrenomedullin, we investigated its plasma concentrations in 49 patients with heart failu re. Plasma adrenomedullin levels increased significantly with advancin g severity of the disease (New York Heart Association functional class I, 4.1 +/- 1.0; II, 5.6 +/- 1.6; III, 6.4 +/- 0.8; IV, 13.2 +/- 6.8 ( fmol/l)). Plasma adrenomedullin was correlated with pulmonary artery p ressure (r = 0.44, p = 0.0114) and pulmonary capillary wedge pressure (r = 0.53, p = 0.0002). These findings indicate that adrenomedullin ma y play some important role in the pathophysiologic makeup of heart fai lure by its vasodilating effects against the concomitant exaggeration of humor presser agents such as catecholamine and the renin-angiotensi n system. Hemodynamic changes in pulmonary circulation may have some i nfluence on the increased synthesis and secretion of plasma adrenomedu llin in chronic congestive heart failure.