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The clinical use of bioactive adrenomedullin and proenkephalin A in detecting congestion, renal dysfunction and clinical outcomes in two independent acute heart failure cohorts

Session Moderated Poster Session - Acute heart failure

Speaker John Molvin

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure: Biomarkers
  • Session type : Moderated Posters

Authors : J Molvin (Malmo,SE), A Jujic (Malmo,SE), S Navarin (Rome,IT), O Melander (Malmo,SE), G Zoccoli (Rome,IT), O Hartmann (Hennigsdorf,DE), A Bergmann (Hennigsdorf,DE), J Struck (Hennigsdorf,DE), E Bachus (Malmo,SE), S Di Somma (Rome,IT), M Magnusson (Malmo,SE)

Authors:
J Molvin1 , A Jujic2 , S Navarin3 , O Melander2 , G Zoccoli3 , O Hartmann4 , A Bergmann4 , J Struck4 , E Bachus2 , S Di Somma5 , M Magnusson1 , 1Skane University Hospital, Dept of Cardiology - Malmo - Sweden , 2Lund University, Dept of Clinical Sciences - Malmo - Sweden , 3Sapienza University of Rome - Rome - Italy , 4Sphingotec GmbH - Hennigsdorf - Germany , 5GREAT Network - Rome - Italy ,

Citation:

Background: 
In an acute heart failure (AHF) setting, proenkephalin A 119-159 (PENK) has emerged as a promising prognostic marker for predicting worsening renal function (WRF), while biologically active adrenomedullin (bio-ADM) has been proposed as a potential marker for congestion.

Aims:
We examined the diagnostic value of bio-ADM in congestion and PENK in WRF, and investigated the prognostic value of bio-ADM and PENK regarding mortality, rehospitalisation, and length of hospital stay in two separate European AHF cohorts.

Methods:
Bio-ADM and PENK were measured in 530 subjects hospitalized for AHF in two cohorts: the Swedish Heart and Brain Failure Investigation study - Malmö (HARVEST- Malmö) (n=322, 30.1% female; mean age 75.1 years; 12-months follow-up) and the GREAT Network Rome study (n=208, 54.8% female; mean age 78.5 years; no follow-up).

Results: 
PENK was associated with WRF (AUC 0.65, p<0.001). In multi-variable logistic regression analysis of the pooled cohort, PENK showed an independent association with WRF (adjusted odds ratio [aOR] 1.74, p=0.004).

Bio-ADM was associated with peripheral oedema (AUC 0.71, p<0.001) which proved to be independent after adjustment (aOR 2.30, p<0.001).

PENK was predictive of in-hospital mortality (OR 2.24, p<0.001).

In the HARVEST-Malmö cohort, both PENK and bio-ADM were predictive of one-year mortality (aOR 1.34, p=0.038 and aOR 1.39, p=0.030). Furthermore, bio-ADM was associated with rehospitalization (aOR 1.25, p=0.007) and length of hospital stay (ß 0.702, p=0.005).

Conclusion:
In two European AHF cohorts, bio-ADM and PENK perform as suitable biomarkers for early detection of congestion severity and WRF occurrence, respectively, and are associated with pertinent clinical outcomes.

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