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Bio-adrenomedullin is strongly related to congestion and poor outcome in patients with worsening heart failure

Session Acute heart failure: how to improve survival

Speaker Jozine Ter Maaten

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Biomarkers
  • Session type : Rapid Fire Abstracts

Authors : J M Ter Maaten (Groningen,NL), D Kremer (Groningen,NL), BG Demissei (Groningen,NL), J Struck (Hennigsdorf,DE), AA Voors (Groningen,NL)

Authors:
J M Ter Maaten1 , D Kremer1 , BG Demissei1 , J Struck2 , AA Voors1 , 1University Medical Center Groningen - Groningen - Netherlands , 2Sphingotec - Hennigsdorf - Germany ,

Topic(s):
Acute Heart Failure: Biomarkers

Background:
Adrenomedullin (ADM) is a vasodilatory hormone with natriuretic effects that has been postulated to play a role in tissue congestion. Its specific pathophysiological function however remains unclear. We therefore evaluated clinical and biological factors associated with plasma biologically active ADM (bio-ADM).

Methods:
Plasma bio-ADM was measured in 2,189 patients with acute or worsening heart failure enrolled in the BIOSTAT-CHF study. We utilized regression models and network analysis tools to identify associations of bio-ADM with clinical and biological variables. Prognostic value of bio-ADM was analyzed using Cox regression.

Results:
Acute or worsening heart failure patients with higher bio-ADM levels were significantly older, had a higher BMI and NYHA class and had more signs and symptoms of congestion (all p<0.01).  In multivariable regression analysis, higher plasma bio-ADM levels were associated with higher BMI and more severe edema, as well as higher FGF23, aldosterone, and CRP levels (all p<0.03). Conversely higher plasma bio-ADM was significantly associated with lower sodium levels. Interestingly, plasma bio-ADM clustered strongly with markers of congestion, such as FGF23, (NT-pro)BNP and a clinical congestion score (CCS). Plasma bio-ADM was independently associated with an increased risk of all-cause mortality and heart failure rehospitalization (Hazard ratio: 1.18 per log increase (1.08-1.30), p<0.001).

Conclusions:
Bio-ADM is strongly associated with clinical variables and biomarkers related to congestion, RAAS activation and inflammation. Also, higher bio-ADM levels are associated with an increased risk of adverse outcome. As such, bio-ADM may play a significant role in heart failure pathophysiology and might be used for risk stratification and to guide treatment.

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