Plasma adrenomedullin, a new independent predictor of prognosis in patients with chronic heart failure

Background Adrenomedullin, a potent endogenous vasodilating and natriuretic peptide, may play an important role in the pathophysiology of chronic hear t failure. Plasma levels of immunoreactive adrenomedullin were examined for prediction of prognosis in chronic heart failure. Methods and Results Plasma levels of immunoreactive-ADM (ir-ADM) were measu red by radioimmunoassay in 117 chronic heart failure patients with idiopath ic or ischaemic cardiomyopathy (mean ejection fraction: 28 +/- 10%, in the NYHA functional class I/II/III/IV:8/73/29/7, and treated with ACE inhibitor s and diuretics. Plasma levels of immunoreactive adrenomedullin were signif icantly increased in chronic heart failure patients by comparison to contro ls (618 +/- 293 pg . ml(-1) vs 480 +/- 135 pg . ml(-1) P=0.01). During the follow-up period (237 +/- 137 days) 14 cardiovascular deaths and four urgen t cardiac transplantations occurred. In the univariate Cox model, immunorea ctive adrenomedullin plasma levels were related to prognosis (P=0.004). A m ultivariate analysis including heart rate, systolic blood pressure, NYHA cl ass, left ventricular ejection fraction, left ventricular echocardiographic end-diastolic diameter, plasma levels of immunoreactive adrenomedullin, en dothelin-1, norepinephrine and atrial natriuretic peptide was performed: pl asma levels of immunoreactive adrenomedullin (P=0.03), of endothelin-1 (P=0 .0001), and systolic blood pressure (P=0.003) were significantly associated with outcome. Conclusion Our results suggest that elevated plasma levels of immunoreactiv e adrenomedullin are an independent predictor of prognosis in predominantly mild to moderate chronic heart failure treated by conventional therapy and provide additional prognostic information. (Eur Heart J 2000; 21: 1009-101 4) (C) 2000 The European Society of Cardiology.