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Fialek B, De Roquetaillade C, Pruc M, Navolokina A, Chirico F, Ladny JR, Peacock FW, Szarpak L. Systematic review with meta-analysis of mid-regional pro-adrenomedullin (MR-proadm) as a prognostic marker in Covid-19-hospitalized patients. Ann Med 2023; 55:379-387. [PMID: 36607317 PMCID: PMC9828692 DOI: 10.1080/07853890.2022.2162116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Mid-regional pro-adrenomedullin (MR-proADM) is useful for risk stratification in patients with sepsis and respiratory infections. The study's purpose was to assess the available data and determine the association between MR-proADM levels and mortality in COVID-19 participants. METHODS A comprehensive literature search of medical electronic databases was performed including PubMed, Web of Science, Scopus, Cochrane, and grey literature for relevant data published from 1 January 2020, to 20 November 2022. Mean differences (MD) with 95% confidence intervals (CI) were calculated. RESULTS Fourteen studies reported MR-proADM levels in survivors vs. non-survivors of COVID-19 patients. Pooled analysis showed that MR-proADM level in the survivor group was 0.841 ± 0.295 nmol/L for patients who survive COVID-19, compared to 1.692 ± 0.761 nmol/L for non-survivors (MD = -0.78; 95%CI: -0.92 to -0.64; p < 0.001). CONCLUSIONS The main finding of this study is that mortality of COVID-19 is linked to MR-proADM levels, according to this meta-analysis. The use of MR-proADM might be extremely beneficial in triaging, assessing probable therapy escalation, predicting potential complications during therapy or significant clinical deterioration of patients, and avoiding admission which may not be necessary. Nevertheless, in order to confirm the obtained data, it is necessary to conduct large prospective studies that will address the potential diagnostic role of MR-proADM as a marker of COVID-19 severity.KEY MESSAGESSeverity of COVID-19 seems to be linked to MR-proADM levels and can be used as a potential marker for predicting a patient's clinical course.The use of MR-proADM might be beneficial in triaging, assessing probable therapy escalation, predicting potential complications during therapy or significant clinical deterioration of patients, and avoiding admission which may not be necessary.For patients with COVID-19, MR-proADM may be an excellent prognostic indicator because it is a marker of endothelial function that may predict the precise impact on the equilibrium between vascular relaxation and contraction and lowers platelet aggregation inhibitors, coagulation inhibitors, and fibrinolysis activators in favor of clotting factors.
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Affiliation(s)
- Bartosz Fialek
- Rheumatology Department, Marshal Józef Piłsudski Memorial Hospital, Plonsk, Poland
| | - Charles De Roquetaillade
- Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, Paris, France.,UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular Markers in Stressed Conditions (MASCOT), Paris University, Paris, France
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Alla Navolokina
- Department of Public health and Social Medicine, International European University, Kyiv, Ukraine
| | - Francesco Chirico
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Health Service Department, Italian State Police, Ministry of the Interior, Milan, Italy
| | - Jerzy Robert Ladny
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland.,Department of Emergency Medicine, Bialystok Medical University, Bialystok, Poland
| | - Frank William Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Houston, TX, USA
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Houston, TX, USA.,Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.,Research Institute, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
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Pietraszko P, Zorawski M, Bielecka E, Sielatycki P, Zbroch E. Mid-Regional Proadrenomedullin in COVID-19-May It Act as a Predictor of Prolonged Cardiovascular Complications? Int J Mol Sci 2023; 24:16821. [PMID: 38069140 PMCID: PMC10705931 DOI: 10.3390/ijms242316821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
The rising prevalence of cardiovascular disease (CVD) and the impact of the SARS-CoV-2 pandemic have both led to increased mortality rates, affecting public health and the global economy. Therefore, it is essential to find accessible, non-invasive prognostic markers capable of identifying patients at high risk. One encouraging avenue of exploration is the potential of mid-regional proadrenomedullin (MR-proADM) as a biomarker in various health conditions, especially in the context of CVD and COVID-19. MR-proADM presents the ability to predict mortality, heart failure, and adverse outcomes in CVD, offering promise for improved risk assessment and treatment strategies. On the other hand, an elevated MR-proADM level is associated with disease severity and cytokine storms in patients with COVID-19, making it a predictive indicator for intensive care unit admissions and mortality rates. Moreover, MR-proADM may have relevance in long COVID, aiding in the risk assessment, triage, and monitoring of individuals at increased risk of developing prolonged cardiac issues. Our review explores the potential of MR-proADM as a predictor of enduring cardiovascular complications following COVID-19 infection.
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Affiliation(s)
| | | | | | | | - Edyta Zbroch
- Department of Internal Medicine and Hypertension, Medical University of Bialystok, 15-089 Bialystok, Poland; (P.P.); (M.Z.); (E.B.); (P.S.)
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Komarova N, Panova O, Titov A, Kuznetsov A. Aptamers Targeting Cardiac Biomarkers as an Analytical Tool for the Diagnostics of Cardiovascular Diseases: A Review. Biomedicines 2022; 10:biomedicines10051085. [PMID: 35625822 PMCID: PMC9138532 DOI: 10.3390/biomedicines10051085] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
The detection of cardiac biomarkers is used for diagnostics, prognostics, and the risk assessment of cardiovascular diseases. The analysis of cardiac biomarkers is routinely performed with high-sensitivity immunological assays. Aptamers offer an attractive alternative to antibodies for analytical applications but, to date, are not widely practically implemented in diagnostics and medicinal research. This review summarizes the information on the most common cardiac biomarkers and the current state of aptamer research regarding these biomarkers. Aptamers as an analytical tool are well established for troponin I, troponin T, myoglobin, and C-reactive protein. For the rest of the considered cardiac biomarkers, the isolation of novel aptamers or more detailed characterization of the known aptamers are required. More attention should be addressed to the development of dual-aptamer sandwich detection assays and to the studies of aptamer sensing in alternative biological fluids. The universalization of aptamer-based biomarker detection platforms and the integration of aptamer-based sensing to clinical studies are demanded for the practical implementation of aptamers to routine diagnostics. Nevertheless, the wide usage of aptamers for the diagnostics of cardiovascular diseases is promising for the future, with respect to both point-of-care and laboratory testing.
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Ouyang M, Tu D, Tong L, Sarwar M, Bhimaraj A, Li C, Coté GL, Di Carlo D. A review of biosensor technologies for blood biomarkers toward monitoring cardiovascular diseases at the point-of-care. Biosens Bioelectron 2021; 171:112621. [PMID: 33120234 DOI: 10.1016/j.bios.2020.112621] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 09/06/2020] [Accepted: 09/14/2020] [Indexed: 01/03/2023]
Abstract
Cardiovascular diseases (CVDs) cause significant mortality globally. Notably, CVDs disproportionately negatively impact underserved populations, such as those that are economically disadvantaged and often located in remote regions. Devices to measure cardiac biomarkers have traditionally been focused on large instruments in a central laboratory but the development of affordable, portable devices that measure multiple cardiac biomarkers at the point-of-care (POC) are needed to improve clinical outcomes for patients, especially in underserved populations. Considering the enormity of the global CVD problem, complexity of CVDs, and the large candidate pool of biomarkers, it is of great interest to evaluate and compare biomarker performance and identify potential multiplexed panels that can be used in combination with affordable and robust biosensors at the POC toward improved patient care. This review focuses on describing the known and emerging CVD biosensing technologies for analysis of cardiac biomarkers from blood. Initially, the global burden of CVDs and the standard of care for the primary CVD categories, namely heart failure (HF) and acute coronary syndrome (ACS) including myocardial infarction (MI) are discussed. The latest United States, Canadian and European society guidelines recommended standalone, emerging, and add-on cardiac biomarkers, as well as their combinations are then described for the prognosis, diagnosis, and risk stratification of CVDs. Finally, both commercial in vitro biosensing devices and recent state-of-art techniques for detection of cardiac biomarkers are reviewed that leverage single and multiplexed panels of cardiac biomarkers with a view toward affordable, compact devices with excellent performance for POC diagnosis and monitoring.
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Affiliation(s)
- Mengxing Ouyang
- Department of Bioengineering, University of California, Los Angeles, 420 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Dandan Tu
- Department of Biomedical Engineering, Texas A&M University, 400 Bizzell St, College Station, TX, 77843, USA
| | - Lin Tong
- Nanobioengineering/Bioelectronics Lab, Department of Biomedical Engineering, Florida International University, 10555 West Flagler Street, Miami, FL, 33174, USA
| | - Mehenur Sarwar
- Nanobioengineering/Bioelectronics Lab, Department of Biomedical Engineering, Florida International University, 10555 West Flagler Street, Miami, FL, 33174, USA
| | - Arvind Bhimaraj
- Department of Cardiology, Houston Methodist J.C. Walter Transplant Center, Houston Methodist Hospital, 6550 Fannin St., Houston, TX, 77030, USA
| | - Chenzhong Li
- Nanobioengineering/Bioelectronics Lab, Department of Biomedical Engineering, Florida International University, 10555 West Flagler Street, Miami, FL, 33174, USA.
| | - Gerard L Coté
- Department of Biomedical Engineering, Texas A&M University, 400 Bizzell St, College Station, TX, 77843, USA; Center for Remote Health Technologies & Systems, Texas A&M Engineering Experiment Station, 101 Bizzell St, College Station, TX, 77840, USA.
| | - Dino Di Carlo
- Department of Bioengineering, University of California, Los Angeles, 420 Westwood Plaza, Los Angeles, CA, 90095, USA.
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Shrivastava A, Haase T, Zeller T, Schulte C. Biomarkers for Heart Failure Prognosis: Proteins, Genetic Scores and Non-coding RNAs. Front Cardiovasc Med 2020; 7:601364. [PMID: 33330662 PMCID: PMC7719677 DOI: 10.3389/fcvm.2020.601364] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022] Open
Abstract
Heart failure (HF) is a complex disease in which cardiomyocyte injury leads to a cascade of inflammatory and fibrosis pathway activation, thereby causing decrease in cardiac function. As a result, several biomolecules are released which can be identified easily in circulating body fluids. The complex biological processes involved in the development and worsening of HF require an early treatment strategy to stop deterioration of cardiac function. Circulating biomarkers provide not only an ideal platform to detect subclinical changes, their clinical application also offers the opportunity to monitor disease treatment. Many of these biomarkers can be quantified with high sensitivity; allowing their clinical application to be evaluated beyond diagnostic purposes as potential tools for HF prognosis. Though the field of biomarkers is dominated by protein molecules, non-coding RNAs (microRNAs, long non-coding RNAs, and circular RNAs) are novel and promising biomarker candidates that encompass several ideal characteristics required in the biomarker field. The application of genetic biomarkers as genetic risk scores in disease prognosis, albeit in its infancy, holds promise to improve disease risk estimation. Despite the multitude of biomarkers that have been available and identified, the majority of novel biomarker candidates are not cardiac-specific, and instead may simply be a readout of systemic inflammation or other pathological processes. Thus, the true value of novel biomarker candidates in HF prognostication remains unclear. In this article, we discuss the current state of application of protein, genetic as well as non-coding RNA biomarkers in HF risk prognosis.
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Affiliation(s)
- Apurva Shrivastava
- Clinic for Cardiology, University Heart and Vascular Center, University Medical Center Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, University Medical Center Eppendorf, Hamburg, Germany
| | - Tina Haase
- Clinic for Cardiology, University Heart and Vascular Center, University Medical Center Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, University Medical Center Eppendorf, Hamburg, Germany
| | - Tanja Zeller
- Clinic for Cardiology, University Heart and Vascular Center, University Medical Center Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, University Medical Center Eppendorf, Hamburg, Germany
| | - Christian Schulte
- Clinic for Cardiology, University Heart and Vascular Center, University Medical Center Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, University Medical Center Eppendorf, Hamburg, Germany.,King's British Heart Foundation Centre, King's College London, London, United Kingdom
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Chen Z, Zhu Y, Zhang L. Study of three novel biomarkers, MR-proADM, midkine, and stromelysin2, and peripheral atherosclerosis in a Chinese Han population: A case-control study. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220960558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Midregional pro-adrenomedullin (MR-proADM), midkine, and stromelysin2 (ST2) are novel cardiac biomarkers associated with heart failure and atherosclerotic diseases like stable ischemic disease and acute coronary syndrome. The potential association between these three biomarkers and peripheral artery disease (PAD) remains unclear. The aim of this study was to assess the correlation between these three biomarkers and their association with PAD in the Chinese Han population. This study included 224 patients suspected of having coronary artery disease (CAD). All subjects underwent coronary angiography and carotid and subclavian ultrasound assessment for detection of coronary and peripheral atherosclerosis and were divided into two groups according to whether they had PAD or not. Pearson’s correlation coefficient r was calculated, and multivariable logistic regression analysis was conducted to represent the associations of these biomarkers and PAD. The study included 133 patients with PAD and 91 non-PAD controls and these two groups had similar values for age, ST2, hematocrit, hemoglobin, red blood cell counts, creatinine and CAD ratio, smoking, and type 2 diabetes (all p > 0.05). Compared with non-PAD controls, patients with PAD had lower levels of MR-proADM and midkine and higher levels of TC, LDL-C, and fasting blood sugar (FBS) (all p < 0.05). MR-proADM was positively and ST2 negatively correlated with midkine (all p < 0.05). Compared with females, male patients had higher values of MR-proADM ( p < 0.05) and similar levels of ST2 and midkine (all p > 0.05). Multivariable regression analysis identified FBS as a risk predictor (OR: 1.163, 95% CI: 1.108–1.401, p = 0.014) and MR-proADM as a protective factor (OR: 0.720, 95% CI: 0.529–0.920, p = 0.037) of PAD. Three novel biomarkers, MR-proADM, midkine, and ST2, are internally related, and MR-proADM is gender-specific and a protective factor of peripheral atherosclerosis in the Chinese Han population studied. Clinical Trial: ChiCTR-DDD-17013908
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Affiliation(s)
- Zhong Chen
- Affiliated Sixth People’s Hospital East, Shanghai University of Medicine and Health Sciences; Shanghai Jiao Tong University Affiliated Sixth People’s Hospital East, Shanghai, P.R. China
- College of Fisheries and Life Science, Shanghai Ocean University, Shanghai, P.R. China
| | - Yawen Zhu
- College of Fisheries and Life Science, Shanghai Ocean University, Shanghai, P.R. China
| | - Lili Zhang
- Affiliated Sixth People’s Hospital East, Shanghai University of Medicine and Health Sciences; Shanghai Jiao Tong University Affiliated Sixth People’s Hospital East, Shanghai, P.R. China
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7
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Bellia C, Agnello L, Lo Sasso B, Bivona G, Raineri MS, Giarratano A, Ciaccio M. Mid-regional pro-adrenomedullin predicts poor outcome in non-selected patients admitted to an intensive care unit. Clin Chem Lab Med 2019; 57:549-555. [PMID: 30157027 DOI: 10.1515/cclm-2018-0645] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/21/2018] [Indexed: 01/19/2023]
Abstract
Background Mortality risk and outcome in critically ill patients can be predicted by scoring systems, such as APACHE and SAPS. The identification of prognostic biomarkers, simple to measure upon admission to an intensive care unit (ICU) is an open issue. The aim of this observational study was to assess the prognostic value of plasma mid-regional pro-adrenomedullin (MR-proADM) at ICU admission in non-selected patients in comparison to Acute Physiology and Chronic Health Evaluation II (APACHEII) and Simplified Acute Physiology Score II (SAPSII) scores. Methods APACHEII and SAPSII scores were calculated after 24 h from ICU admission. Plasma MR-proADM levels were measured by TRACE-Kryptor on admission (T0) and after 24 h (T24). The primary endpoint was intra-hospital mortality; secondary endpoint was length of stay (LOS). Results One hundred and twenty-six consecutive non-selected patients admitted to an ICU were enrolled. Plasma MR-proADM levels were correlated with LOS (r=0.28; p=0.0014 at T0; r=0.26; p=0.005 at T24). Multivariate analysis showed that T0 MR-proADM was a significant predictor of mortality (odds ratio [OR]: 1.27; 95% confidence interval [95%CI]: 1.03-1.55; p=0.022). Receiver operating characteristic curves analysis revealed that MR-proADM on ICU admission identified non-survivors with high accuracy, not inferior to the one of APACHEII and SAPSII scores (area under the curve [AUC]: 0.71; 95%CI: 0.62-0.78; p=0.0002 for MR-proADM; AUC: 0.71; 95%CI: 0.62-0.79; p<0.0001 for APACHEII; AUC: 0.8; 95%CI: 0.71-0.87; p<0.0001 for SAPSII). Conclusions Our findings point out a role of MR-proADM as a prognostic tool in non-selected patients in ICUs being a reliable predictor of mortality and LOS and support its use on admission to an ICU to help the management of critically ill patients.
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Affiliation(s)
- Chiara Bellia
- Department of Biopathology and Medical Biotechnologies, Section of Clinical Biochemistry and Clinical Molecular Medicine, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Luisa Agnello
- Department of Biopathology and Medical Biotechnologies, Section of Clinical Biochemistry and Clinical Molecular Medicine, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Bruna Lo Sasso
- Department of Biopathology and Medical Biotechnologies, Section of Clinical Biochemistry and Clinical Molecular Medicine, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Giulia Bivona
- Department of Biopathology and Medical Biotechnologies, Section of Clinical Biochemistry and Clinical Molecular Medicine, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Maurizio Santi Raineri
- Department of Biopathology and Medical Biotechnologies, Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Antonino Giarratano
- Department of Biopathology and Medical Biotechnologies, Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Marcello Ciaccio
- Department of Biopathology and Medical Biotechnologies, Section of Clinical Biochemistry and Clinical Molecular Medicine, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
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Abstract
INTRODUCTION The term cardiorenal syndrome (CRS) describes the progressive pathology and interactions that develop upon heart and kidney failure. The definition of CRS is not firmly established and has evolved gradually during the last decade. The main clinical challenges associated with CRS are the lack of tools for early disease diagnosis and the inability to predict the development of cardiorenal pathophysiology. Currently several biomarkers have been proposed for improving CRS patient management. However, validation studies are needed to implement these initial findings to the clinical setting. Areas covered: In this review the database PubMed was used for a literature search on the definition and classification of CRS as well as biomarkers for CRS diagnosis and prognosis. Expert opinion: A universally acceptable classification system for CRS is not available. Thus, acquiring mechanistic insights relative to the pathophysiology of the disease is challenging. Reported biomarkers include well-established markers for heart/renal dysfunction and inflammation. Some proteins expressed in both organs have also been associated with CRS, yet their link to disease pathophysiology and organ cross-talk is missing. Establishing the link between deregulated molecular pathways and CRS phenotypes is required to define biological relevance of existing findings and ultimately biology-driven markers and targets.
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Affiliation(s)
- Eleni Petra
- a Biotechnology Division, Biomedical Research Foundation , Academy of Athens (BRFAA) , Athens , Greece
| | - Jerome Zoidakis
- a Biotechnology Division, Biomedical Research Foundation , Academy of Athens (BRFAA) , Athens , Greece
| | - Antonia Vlahou
- a Biotechnology Division, Biomedical Research Foundation , Academy of Athens (BRFAA) , Athens , Greece
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Graziadio S, O’Leary RA, Stocken DD, Power M, Allen AJ, Simpson AJ, Price DA. Can mid-regional pro-adrenomedullin (MR-proADM) increase the prognostic accuracy of NEWS in predicting deterioration in patients admitted to hospital with mild to moderately severe illness? A prospective single-centre observational study. BMJ Open 2019; 8:e020337. [PMID: 30798282 PMCID: PMC6278796 DOI: 10.1136/bmjopen-2017-020337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess the value added to the National Early Warning Score (NEWS) by mid-regional pro-adrenomedullin (MR-proADM) blood level in predicting deterioration in mild to moderately ill people. DESIGN Prospective observational study. SETTING The Medical Admissions Suite of the Royal Victoria Infirmary, Newcastle. PARTICIPANTS 300 adults with NEWS between 2 and 5 on admission. Exclusion criteria included receiving palliative care, or admitted for social reasons or self-harming. Patients were enrolled between September and December 2015, and followed up for 30 days after discharge. OUTCOME MEASURE The primary outcome measure was the proportion of patients who, within 72 hours, had an acuity increase, defined as any combination of an increase of at least 2 in the NEWS; transfer to a higher-dependency bed or monitored area; death; or for those discharged from hospital, readmission for medical reasons. RESULTS NEWS and MR-proADM together predicted acuity increase more accurately than NEWS alone, increasing the area under the curve (AUC) to 0.61 (95% CI 0.54 to 0.69) from 0.55 (95% CI 0.48 to 0.62). When the confounding effects of presence of chronic obstructive pulmonary disease or heart failure and interaction with MR-proADM were included, the prognostic accuracy further increased the AUC to 0.69 (95% CI 0.63 to 0.76). CONCLUSIONS MR-proADM is potentially a clinically useful biomarker for deterioration in patients admitted to hospital with a mild to moderately severe acute illness, that is, with NEWS between 2 and 5. As a growing number of National Health Service hospitals are routinely recording the NEWS on their clinical information systems, further research should assess the practicality and use of developing a decision aid based on admission NEWS, MR-proADM level, and possibly other clinical data and other biomarkers that could further improve prognostic accuracy.
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Affiliation(s)
- Sara Graziadio
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Rachel Amie O’Leary
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Department of Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Power
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle upon Tyne, UK
| | - A John Simpson
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle upon Tyne, UK
| | - David Ashley Price
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
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Eckart A, Hauser SI, Kutz A, Haubitz S, Hausfater P, Amin D, Amin A, Huber A, Mueller B, Schuetz P. Combination of the National Early Warning Score (NEWS) and inflammatory biomarkers for early risk stratification in emergency department patients: results of a multinational, observational study. BMJ Open 2019; 9:e024636. [PMID: 30782737 PMCID: PMC6340461 DOI: 10.1136/bmjopen-2018-024636] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The National Early Warning Score (NEWS) helps to estimate mortality risk in emergency department (ED) patients. This study aimed to investigate whether the prognostic value of the NEWS at ED admission could be further improved by adding inflammatory blood markers (ie, white cell count (WCC), procalcitonin (PCT) and midregional-proadrenomedullin (MR-proADM). DESIGN Secondary analysis of a multinational, observational study (TRIAGE study, March 2013-October 2014). SETTING Three tertiary care centres in France, Switzerland and the USA. PARTICIPANTS A total of 1303 adult medical patients with complete NEWS data seeking ED care were included in the final analysis. NEWS was calculated retrospectively based on admission data. MAIN OUTCOME MEASURES The primary outcome was all-cause 30-day mortality. Secondary outcome was intensive care unit (ICU) admission. We used multivariate regression analyses to investigate associations of NEWS and blood markers with outcomes and area under the receiver operating curve (AUC) as a measure of discrimination. RESULTS Of the 1303 included patients, 54 (4.1%) died within 30 days. The NEWS alone showed fair prognostic accuracy for all-cause 30-day mortality (AUC 0.73), with a multivariate adjusted OR of 1.26 (95% CI 1.13 to 1.40, p<0.001). The AUCs for the prediction of mortality using the inflammatory markers WCC, PCT and MR-proADM were 0.64, 0.71 and 0.78, respectively. Combining NEWS with all three blood markers or only with MR-proADM clearly improved discrimination with an AUC of 0.82 (p=0.002). Combining the three inflammatory markers with NEWS improved prediction of ICU admission (AUC 0.70vs0.65 when using NEWS alone, p=0.006). CONCLUSION NEWS is helpful in risk stratification of ED patients and can be further improved by the addition of inflammatory blood markers. Future studies should investigate whether risk stratification by NEWS in addition to biomarkers improve site-of-care decision in this patient population. TRIAL REGISTRATION NUMBER NCT01768494; Post-results.
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Affiliation(s)
- Andreas Eckart
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephanie Isabelle Hauser
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of Infectious Diseases, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Pierre Hausfater
- Emergency Departement, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Sorbonne Universités UPMC-Univ Paris 06, UMRS INSERM 1166, IHUC ICAN, Paris, France
| | | | - Adina Amin
- Morton Plant Hospital, Clearwater, Florida, USA
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
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Lyngbakken MN, Myhre PL, Røsjø H, Omland T. Novel biomarkers of cardiovascular disease: Applications in clinical practice. Crit Rev Clin Lab Sci 2018; 56:33-60. [DOI: 10.1080/10408363.2018.1525335] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Magnus Nakrem Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Peder Langeland Myhre
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
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12
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Cardiovascular biomarkers and risk of low-energy fractures among middle-aged men and women-A population-based study. PLoS One 2018; 13:e0203692. [PMID: 30216373 PMCID: PMC6138405 DOI: 10.1371/journal.pone.0203692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/25/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Low-energy fractures are a growing health challenge as their incidence increases with advancing age. As cardiovascular instability may be associated with higher likelihood of traumatic falls, we aimed to investigate the associations between four cardiovascular biomarkers and the risk of low-energy fractures in a middle-aged population. METHODS A total of 5291 individuals from the prospective Malmö Diet and Cancer (MDC) study (mean age, 57 years; 59% women) with data on baseline levels of four cardiovascular biomarkers: mid-regional-fragment of pro-adrenomedullin-peptide (MR-pro-ADM), mid-regional-fragment of pro-atrial-natriuretic-peptide (MR-proANP), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-terminal-pro-arginine-vasopressin (CT-pro-AVP/Copeptin) were included. The associations between biomarker levels and first incident low-energy fracture were tested in Cox proportional-hazard models, taking potential interactions and traditional risk factors into account. RESULTS Participants were followed for a median time of 21.0 years, during which 1002 subjects (19%) experienced at least one low-energy fracture. Subjects with incident fracture were older, more likely to be women, had lower BMI and higher prevalence of previous fractures. Among biomarkers, there was a significant interaction between gender and MR-pro-ADM on the risk of fracture (p = 0.002). MR-pro-ADM predicted fractures in men only (hazard ratio, 1.23; 95% CI 1.09-1.40; p = 0.001), whereas there was no association among women. Levels of MR-pro-ANP, NT-pro-BNP and CT-pro-AVP did not predict fractures. CONCLUSIONS Higher circulating levels of MR-pro-ADM predict low-energy fractures among middle-aged-men, whereas levels of MR-pro-ANP, NT-pro-BNP and CT-pro-AVP are not associated with increased fracture risk. Further controlled studies should test the hypothesis whether MR-pro-ADM may improve prediction of bone fractures.
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Cui K, Huang W, Fan J, Lei H. Midregional pro-atrial natriuretic peptide is a superior biomarker to N-terminal pro-B-type natriuretic peptide in the diagnosis of heart failure patients with preserved ejection fraction. Medicine (Baltimore) 2018; 97:e12277. [PMID: 30200170 PMCID: PMC6133645 DOI: 10.1097/md.0000000000012277] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/15/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To explore that if mid-regional sequence of pro-A-type natriuretic peptide (MR-proANP) may have a good value of diagnosis in heart failure with preserved ejection fraction (HFpEF) compared with N-terminal pro-B-type natriuretic peptide (NT-proBNP). METHODS Participants with cardiovascular disease who were enrolled in this study were divided into the nonheart failure (non-HF) group (n = 75), HFpEF group (n = 65), and HF with reduced ejection fraction (HFrEF) group (n = 50). The MR-proANP and NT-proBNP levels in plasma from all patients were measured by enzyme-linked immunosorbent assay. RESULTS The plasma levels of MR-proANP and NT-proBNP in HFpEF and HFrEF groups were higher than those in non-HF group (P < .05). MR-proANP levels were significantly different (P < .05) in different New York Heart Association class patients with HFpEF. In the diagnostic analysis area under the curve of MR-proANP (0.844) was higher than that of NT-proBNP (0.518, P < .001). The left atrial volume index in the HFrEF group was higher than HFpEF group (P < .05); however, both of these groups had a higher index than non-HF group (P < .05). CONCLUSION Results indicated that MR-proANP may be more sensitive and specific than NT-proBNP in diagnosing HFpEF. It may be used as a potential diagnostic biomarker in patients with HFpEF.
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Affiliation(s)
- Kun Cui
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University
- Department of Cardiology, Chongqing General Hospital
| | - Wei Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University
| | - Jinqi Fan
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Han Lei
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University
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14
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Precursor proadrenomedullin influences cardiomyocyte survival and local inflammation related to myocardial infarction. Proc Natl Acad Sci U S A 2018; 115:E8727-E8736. [PMID: 30166452 DOI: 10.1073/pnas.1721635115] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Increased adrenomedullin (ADM) levels are associated with various cardiac diseases such as myocardial infarction (MI). ADM is cleaved off from the full-length precursor protein proadrenomedullin (ProADM) during its posttranslational processing. To date, no biological effect of ProADM is reported, while ADM infusion leads to antiapoptotic effects and improved cardiac function. Using an MI mouse model, we found an induction of ProADM gene as well as protein expression during the early phase of MI. This was accompanied by apoptosis and increasing inflammation, which substantially influence the post-MI remodeling processes. Simulating ischemia in vitro, we demonstrate that ProADM expression was increased in cardiomyocytes and cardiac fibroblasts. Subsequently, we treated ischemic cardiomyocytes with either ProADM or ADM and found that both proteins increased survival. This effect was diminishable by blocking the ADM1 receptor. To investigate whether ProADM and ADM play a role in the regulation of cardiac inflammation, we analyzed chemokine expression after treatment of cells with both proteins. While ProADM induced an expression of proinflammatory cytokines, thus promoting inflammation, ADM reduced chemokine expression. On leukocytes, both proteins repressed chemokine expression, revealing antiinflammatory effects. However, ProADM but not ADM dampened concurrent activation of leukocytes. Our data show that the full-length precursor ProADM is biologically active by reducing apoptosis to a similar extent as ADM. We further assume that ProADM induces local inflammation in affected cardiac tissue but attenuates exaggerated inflammation, whereas ADM has low impact. Our data suggest that both proteins are beneficial during MI by influencing apoptosis and inflammation.
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15
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Idzikowska K, Zielińska M. Midregional pro-atrial natriuretic peptide, an important member of the natriuretic peptide family: potential role in diagnosis and prognosis of cardiovascular disease. J Int Med Res 2018; 46:3017-3029. [PMID: 30027789 PMCID: PMC6134641 DOI: 10.1177/0300060518786907] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Midregional pro-atrial natriuretic peptide (MR-proANP), first isolated in 1981, is a novel peptide with multiple biological functions, especially within the cardiovascular system. This peptide plays an important role in many processes, including natriuresis, diuresis, and other physiological and pathophysiological pathways in the human body. Several electronic databases (PubMed, EBSCO, Scopus, and ScienceDirect) were analyzed in the present literature review. The aim of this study was to elucidate the wide roles of MR-proANP, which can be analyzed because of the development of a new sandwich immunoassay, and to determine the possible diagnostic and prognostic implications of MR-proANP on cardiovascular disease and other disorders. The studies discussed in this literature review provide valuable data on the role of ANP in the pathogenesis, diagnostic process, prognosis, and potential therapeutic strategies for disease. Although ANP is mainly associated with cardiovascular disease, it may be used as a biomarker in diabetology, neurology, and metabolic disorders.
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Affiliation(s)
- Karolina Idzikowska
- Intensive Cardiac Therapy Clinic, Department of Invasive Cardiology and Electrocardiology, Medical University, Lodz, Poland
| | - Marzenna Zielińska
- Intensive Cardiac Therapy Clinic, Department of Invasive Cardiology and Electrocardiology, Medical University, Lodz, Poland
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16
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Falkentoft AC, Rørth R, Iversen K, Høfsten DE, Kelbæk H, Holmvang L, Frydland M, Schoos MM, Helqvist S, Axelsson A, Clemmensen P, Jørgensen E, Saunamäki K, Tilsted HH, Pedersen F, Torp-Pedersen C, Kofoed KF, Goetze JP, Engstrøm T, Køber L. MR-proADM as a Prognostic Marker in Patients With ST-Segment-Elevation Myocardial Infarction-DANAMI-3 (a Danish Study of Optimal Acute Treatment of Patients With STEMI) Substudy. J Am Heart Assoc 2018; 7:JAHA.117.008123. [PMID: 29776961 PMCID: PMC6015359 DOI: 10.1161/jaha.117.008123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Midregional proadrenomedullin (MR‐proADM) has demonstrated prognostic potential after myocardial infarction (MI). Yet, the prognostic value of MR‐proADM at admission has not been examined in patients with ST‐segment–elevation MI (STEMI). Methods and Results The aim of this substudy, DANAMI‐3 (The Danish Study of Optimal Acute Treatment of Patients with ST‐segment–elevation myocardial infarction), was to examine the associations of admission concentrations of MR‐proADM with short‐ and long‐term mortality and hospital admission for heart failure in patients with ST‐segment–elevation myocardial infarction. Outcomes were assessed using Cox proportional hazard models and area under the curve using receiver operating characteristics. In total, 1122 patients were included. The median concentration of MR‐proADM was 0.64 nmol/L (25th–75th percentiles, 0.53–0.79). Within 30 days 23 patients (2.0%) died and during a 3‐year follow‐up 80 (7.1%) died and 38 (3.4%) were admitted for heart failure. A doubling of MR‐proADM was, in adjusted models, associated with an increased risk of 30‐day mortality (hazard ratio, 2.67; 95% confidence interval, 1.01–7.11; P=0.049), long‐term mortality (hazard ratio, 3.23; 95% confidence interval, 1.97–5.29; P<0.0001), and heart failure (hazard ratio, 2.71; 95% confidence interval, 1.32–5.58; P=0.007). For 30‐day and 3‐year mortality, the area under the curve for MR‐proADM was 0.77 and 0.78, respectively. For 3‐year mortality, area under the curve (0.84) of the adjusted model marginally changed (0.85; P=0.02) after addition of MR‐proADM. Conclusions Elevation of admission MR‐proADM was associated with long‐term mortality and heart failure, whereas the association with short‐term mortality was borderline significant. MR‐proADM may be a marker of prognosis after ST‐segment–elevation myocardial infarction but does not seem to add substantial prognostic information to established clinical models. Clinical Trial Registration URL: http://www.ClinicalTrials.gov/. Unique identifiers: NCT01435408 and NCT01960933.
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Affiliation(s)
| | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev Hospital University of Copenhagen, Herlev, Denmark
| | - Dan E Høfsten
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | - Martin Frydland
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | - Mikkel M Schoos
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | - Anna Axelsson
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | - Peter Clemmensen
- Division of Cardiology, Department of Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.,Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | - Kari Saunamäki
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | | | - Frants Pedersen
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | | | - Klaus F Kofoed
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet University of Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet University of Copenhagen, Denmark
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17
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Choi JJ, McCarthy MW. The prognostic value of mid-regional pro-adrenomedullin in the evaluation of acute dyspnea. Expert Rev Mol Diagn 2018; 18:147-153. [DOI: 10.1080/14737159.2018.1427069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Justin J. Choi
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Matthew W. McCarthy
- Weill Cornell Medical College, Division of General Internal Medicine, New York-Presbyterian Hospital, New York, NY, USA
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18
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Tzikas S, Palapies L, Bakogiannis C, Zeller T, Sinning C, Baldus S, Bickel C, Vassilikos V, Lackner KJ, Zeiher A, Münzel T, Blankenberg S, Keller T. GDF-15 predicts cardiovascular events in acute chest pain patients. PLoS One 2017; 12:e0182314. [PMID: 28771550 PMCID: PMC5542604 DOI: 10.1371/journal.pone.0182314] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 07/17/2017] [Indexed: 01/27/2023] Open
Abstract
Background Treatment of patients presenting with possible acute myocardial infarction (AMI) is based on timely diagnosis and proper risk stratification aided by biomarkers. We aimed at evaluating the predictive value of GDF-15 in patients presenting with symptoms suggestive of AMI. Methods Consecutive patients presenting with suspected AMI were enrolled in three study centers. Cardiovascular events were assessed during a follow-up period of 6 months with a combined endpoint of death or MI. Results From the 1818 enrolled patients (m/f = 1208/610), 413 (22.7%) had an acute MI and 63 patients reached the combined endpoint. Patients with MI and patients with adverse outcome had higher GDF-15 levels compared with non-MI patients (967.1pg/mL vs. 692.2 pg/L, p<0.001) and with event-free patients (1660 pg/mL vs. 756.6 pg/L, p<0.001). GDF-15 levels were lower in patients with SYNTAX score ≤ 22 (797.3 pg/mL vs. 947.2 pg/L, p = 0.036). Increased GDF-15 levels on admission were associated with a hazard ratio of 2.1 for death or MI (95%CI: 1.67–2.65, p<0.001) in a model adjusted for age and sex and of 1.57 (1.13–2.19, p = 0.008) adjusted for the GRACE score variables. GDF-15 showed a relevant reclassification with regards to the GRACE score with an overall net reclassification index (NRI) of 12.5% and an integrated discrimination improvement (IDI) of 14.56% (p = 0.006). Conclusion GDF-15 is an independent predictor of future cardiovascular events in patients presenting with suspected MI. GDF-15 levels correlate with the severity of CAD and can identify and risk-stratify patients who need coronary revascularization.
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Affiliation(s)
- Stergios Tzikas
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- * E-mail:
| | - Lars Palapies
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
| | - Constantinos Bakogiannis
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Tanja Zeller
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Christoph Sinning
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Stephan Baldus
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Christoph Bickel
- Department of Internal Medicine, Federal Armed Forces Hospital, Koblenz, Germany
| | - Vassilios Vassilikos
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Karl J. Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Andreas Zeiher
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Thomas Münzel
- Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Stefan Blankenberg
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Till Keller
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
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19
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Roever L, Resende ES, Roerver-Borges AS. Impact of pro-atrial natriuretic peptide in atrial fibrillation and stroke. Eur J Prev Cardiol 2017; 24:1239-1241. [PMID: 28452559 DOI: 10.1177/2047487317707832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Leonardo Roever
- 1 Federal University of Uberlândia, Department of Clinical Research, Uberlândia, Brazil
| | - Elmiro Santos Resende
- 1 Federal University of Uberlândia, Department of Clinical Research, Uberlândia, Brazil
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20
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Yuyun MF, Narayan HK, Quinn PA, Struck J, Bergmann A, Hartmann O, Ng LL. Prognostic value of human mature adrenomedullin in patients with acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2017; 18:42-50. [PMID: 26766169 DOI: 10.2459/jcm.0000000000000299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adrenomedullin (ADM) correlates with adverse cardiovascular outcomes in patients with acute myocardial infarction (AMI) and in patients with heart failure. Measurement of human mature ADM (mADM) has been difficult, and recent studies have used its surrogate - the mid-regional pro-ADM (MRproADM). Our objective was to determine whether mADM measured by a novel sandwich immunoassay, using the anti-C-terminal and an anti-mid-regional monoclonal antibody, was prognostic of 30-day, 90-day, 1-year, and 2-year major adverse cardiovascular events (MACEs) in 1111 consecutive patients who have suffered an AMI. We also compared it with the effect of MRproADM in the same patient population. A total of 311 (27.0%) patients experienced the primary endpoint at 2 years follow-up. The median (inter-quartile range) of mADM was significantly higher in patients who experienced a 2-year MACE [60.90 (44.00-86.97)] pg/ml, compared to event-free survivors [49.59 (36.20-68.15)] pg/ml (P < 0.001). mADM, taken as 1 SD of the continuous variable, was predictive of MACEs in multivariate analysis, with hazard ratios [95% confidence intervals (CIs)] at 90 days [1.28 (1.01-1.62)], 1 year [1.31 (1.08-1.59)], and 2 years [1.42 (1.07-1.64)]. It was also independently predictive of death at 1-year [1.52 (1.12-2.05)] and 2-year [1.42 (1.07-1.89)] follow-up. mADM was a better predictor of these outcomes than MRproADM, apart from death at 90 days, and combined death and heart failure hospitalization at 1 and 2 years, respectively. Human mADM can be reliably measured and predicts MACE events at medium-term follow-up, and confirms the paradigm of risk stratification using MRproADM - a surrogate for the active hormone. The relationship between mADM and MACE appears to be a continuum.
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Affiliation(s)
- Matthew F Yuyun
- aDepartment of Cardiovascular Sciences, University of Leicester, NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK bSphingotec GmbH, Hennigsdorf, Germany
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Tolppanen H, Rivas-Lasarte M, Lassus J, Sans-Roselló J, Hartmann O, Lindholm M, Arrigo M, Tarvasmäki T, Köber L, Thiele H, Pulkki K, Spinar J, Parissis J, Banaszewski M, Silva-Cardoso J, Carubelli V, Sionis A, Harjola VP, Mebazaa A. Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock. Ann Intensive Care 2017; 7:6. [PMID: 28050899 PMCID: PMC5209311 DOI: 10.1186/s13613-016-0229-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/20/2016] [Indexed: 12/18/2022] Open
Abstract
Background The clinical CardShock risk score, including baseline lactate levels, was recently shown to facilitate risk stratification in patients with cardiogenic shock (CS). As based on baseline parameters, however, it may not reflect the change in mortality risk in response to initial therapies. Adrenomedullin is a prognostic biomarker in several cardiovascular diseases and was recently shown to associate with hemodynamic instability in patients with septic shock. The aim of our study was to evaluate the prognostic value and association with hemodynamic parameters of bioactive adrenomedullin (bio-ADM) in patients with CS. Methods CardShock was a prospective, observational, European multinational cohort study of CS. In this sub-analysis, serial plasma bio-ADM and arterial blood lactate measurements were collected from 178 patients during the first 10 days after detection of CS. Results Both bio-ADM and lactate were higher in 90-day non-survivors compared to survivors at all time points (P < 0.05 for all). Lactate showed good prognostic value during the initial 24 h (AUC 0.78 at admission and 0.76 at 24 h). Subsequently, lactate returned normal (≤2 mmol/L) in most patients regardless of later outcome with lower prognostic value. By contrast, bio-ADM showed increasing prognostic value from 48 h and beyond (AUC 0.71 at 48 h and 0.80 at 5–10 days). Serial measurements of either bio-ADM or lactate were independent of and provided added value to CardShock risk score (P < 0.001 for both). Ninety-day mortality was more than double higher in patients with high levels of bio-ADM (>55.7 pg/mL) at 48 h compared to those with low bio-ADM levels (49.1 vs. 22.6%, P = 0.001). High levels of bio-ADM were associated with impaired cardiac index, mean arterial pressure, central venous pressure, and systolic pulmonary artery pressure during the study period. Furthermore, high levels of bio-ADM at 48 to 96 h were related to persistently impaired cardiac and end-organ function. Conclusions Bio-ADM is a valuable prognosticator and marker of impaired hemodynamics in CS patients. High levels of bio-ADM may show shock refractoriness and developing end-organ dysfunction and thus help to guide therapeutic approach in patients with CS. Study identifier of CardShock study NCT01374867 at clinicaltrials.gov Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0229-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heli Tolppanen
- INSERM UMR-S942, Paris, France. .,Heart Center, Päijät-Häme Central Hospital, Lahti, Finland. .,Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
| | - Mercedes Rivas-Lasarte
- INSERM UMR-S942, Paris, France.,Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Johan Lassus
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Jordi Sans-Roselló
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Matias Lindholm
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mattia Arrigo
- INSERM UMR-S942, Paris, France.,Department of Cardiology, University Heart Center, 8091, Zürich, Switzerland.,Department of Cardiology, University Hospital Zürich, 8091, Zürich, Switzerland
| | - Tuukka Tarvasmäki
- Department of Emergency Care, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Lars Köber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Holger Thiele
- Medical Clinic II, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lübeck, Germany
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland.,Eastern Finland Laboratory Centre, Kuopio, Finland
| | - Jindrich Spinar
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,International Clinical Research Centre (ICRC), Brno, Czech Republic
| | - John Parissis
- Heart Failure Clinic and Secondary Cardiology Department, Attikon University Hospital, Athens, Greece
| | - Marek Banaszewski
- Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland
| | - Jose Silva-Cardoso
- Department of Cardiology, CINTESIS, Porto Medical School, São João Hospital Center, University of Porto, Porto, Portugal
| | - Valentina Carubelli
- Division of Cardiology, Department of Medical and Surgical Specialties Radiological Sciences and Public Health, University and Civil Hospital of Brescia, Brescia, Italy
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Veli-Pekka Harjola
- Department of Emergency Care, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Alexandre Mebazaa
- INSERM UMR-S942, Paris, France.,Department of Anesthesia and Critical Care, University Hospital Saint Louis Lariboisière, APHP, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France
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Sinning C, Ojeda F, Zeller T, Zengin E, Rupprecht HJ, Lackner KJ, Bickel C, Blankenberg S, Schnabel RB, Westermann D. Cardiovascular Mortality in Chest Pain Patients: Comparison of Natriuretic Peptides With Novel Biomarkers of Cardiovascular Stress. Can J Cardiol 2016; 32:1470-1477. [DOI: 10.1016/j.cjca.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/09/2016] [Accepted: 05/16/2016] [Indexed: 12/01/2022] Open
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Sörensen NA, Shah AS, Ojeda FM, Peitsmeyer P, Zeller T, Keller T, Johannsen SS, Lackner KJ, Griffiths M, Münzel T, Mills NL, Blankenberg S, Schnabel RB. High-sensitivity troponin and novel biomarkers for the early diagnosis of non-ST-segment elevation myocardial infarction in patients with atrial fibrillation. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2016; 5:419-427. [PMID: 26460326 DOI: 10.1177/2048872615611108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/21/2015] [Indexed: 09/17/2023]
Abstract
AIMS To evaluate the diagnostic performance of high-sensitivity troponin I (hsTnI) and other novel biomarkers for diagnosing non-ST-segment elevation myocardial infarction (NSTEMI) in patients with atrial fibrillation. METHODS In an acute chest pain cohort (N=1673), mean age 61.4±13.6 (34% female), we measured hsTnI and 13 established and novel biomarkers reflecting ischaemia, necrosis, inflammation, myocardial stress, angiogenesis on admission and after three hours in order to investigate their diagnostic accuracy for NSTEMI. RESULTS In atrial fibrillation patients (N=299) hsTnI on admission had the best discriminatory ability for NSTEMI (area under the curve 0.97) with only two novel biomarkers, copeptin and heart-type fatty acid binding protein, having area under the curve >0.70. Measured biomarkers showed comparable discriminatory ability in atrial fibrillation and non-atrial fibrillation patients. The combination of hsTnI on admission with additional biomarkers did not clinically significantly improve diagnostic performance. In atrial fibrillation patients, hsTnI concentrations ⩽21.7 ng/L (99th percentile in a healthy German cohort) on admission gave a negative predictive value of ~100% (95% confidence interval 97-100%). The combination of hsTnI on admission and absolute change of hsTnI concentration after three hours of ⩾40 ng/L resulted in a positive predictive value of 81.2% and sensitivity of 88.6%. Diagnostic accuracy was validated in an independent cohort (N=1076). CONCLUSION The diagnostic accuracy of hsTnI in patients with acute chest pain and atrial fibrillation is high and comparable to those without atrial fibrillation. Absolute change in hsTnI concentration enhanced diagnostic performance. No clinically relevant improvement was achieved by adding other biomarkers.
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Affiliation(s)
- Nils A Sörensen
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Anoop Sv Shah
- BHF/University Centre for Cardiovascular Science, UK
| | - Francisco M Ojeda
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Philipp Peitsmeyer
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany
| | - Till Keller
- Department of Cardiology, University Hospital Frankfurt, Germany German Center for Cardiovascular research (DZHK), Partner Site Rhein/Main, Germany
| | - Silke S Johannsen
- Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | | | - Thomas Münzel
- German Center for Cardiovascular research (DZHK), Partner Site Rhein/Main, Germany Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | | | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany
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Cao RY, Zheng H, Guo J, Redfearn DP. Prognostic value of plasma biomarkers in patients with acute coronary syndrome: a review of advances in the past decade. Biomark Med 2016; 10:525-35. [PMID: 27089223 DOI: 10.2217/bmm-2015-0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Acute coronary syndrome (ACS), especially myocardial infarction, commonly known as a heart attack, is a serious life-threatening cardiovascular disease. Despite dramatic therapeutic advances, there have still been more than 20% patients with ACS suffering recurrent adverse cardiovascular events 3 years after disease onset. Therefore, the aim to prevent cardiac death caused by the heart attack remains challenging. Plasma biomarkers, originally developed to complement clinical assessment and electrocardiographic examination for the diagnosis of ACS, have been reported to play important prognostic roles in predicting adverse outcomes. These biomarkers mirror different pathophysiological mechanisms in association with ACS. In this review, we focus on advances of prognostic biomarkers in the past decade for short- and long-term risk assessment and management of patients with ACS.
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Affiliation(s)
- Richard Y Cao
- Department of Cardiology, Shanghai Xuhui Central Hospital/Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai, China
| | - Hongchao Zheng
- Department of Cardiology, Shanghai Xuhui Central Hospital/Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai, China
| | - Junjun Guo
- Department of Cardiology, Shanghai Xuhui Central Hospital/Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai, China
| | - Damian P Redfearn
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada
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25
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Atzler D, Baum C, Ojeda F, Keller T, Cordts K, Schnabel RB, Choe CU, Lackner KJ, Münzel T, Böger RH, Blankenberg S, Schwedhelm E, Zeller T. Low Homoarginine Levels in the Prognosis of Patients With Acute Chest Pain. J Am Heart Assoc 2016; 5:e002565. [PMID: 27076564 PMCID: PMC4859271 DOI: 10.1161/jaha.115.002565] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The endogenous amino acid homoarginine predicts mortality in cerebro- and cardiovascular disease. The objective was to explore whether homoarginine is associated with atrial fibrillation (AF) and outcome in patients with acute chest pain. METHODS AND RESULTS One thousand six hundred forty-nine patients with acute chest pain were consecutively enrolled in this study, of whom 589 were diagnosed acute coronary syndrome (ACS). On admission, plasma concentrations of homoarginine as well as brain natriuretic peptide (BNP), and high-sensitivity assayed troponin I (hsTnI) were determined along with electrocardiography (ECG) variables. During a median follow-up of 183 days, 60 major adverse cardiovascular events (MACEs; 3.8%), including all-cause death, myocardial infarction, or stroke, were registered in the overall study population and 43 MACEs (7.5%) in the ACS subgroup. Adjusted multivariable Cox regression analyses revealed that an increase of 1 SD of plasma log-transformed homoarginine (0.37) was associated with a hazard reduction of 26% (hazard ratio [HR], 0.74; 95% CI, 0.57-0.96) for incident MACE and likewise of 35% (HR, 0.65; 95% CI, 0.49-0.88) in ACS patients. In Kaplan-Meier survival curves, homoarginine was predictive for patients with high-sensitivity assayed troponin I (hsTnI) above 27 ng/L (P<0.05). Last, homoarginine was inversely associated with QTc duration (P<0.001) and prevalent AF (OR, 0.83; 95% CI, 0.71-0.95). CONCLUSION Low plasma homoarginine was identified as a risk marker for incident MACEs in patients with acute chest pain, in particular, in those with elevated hsTnI. Impaired homoarginine was associated with prevalent AF. Further studies are needed to investigate the link to AF and evaluate homoarginine as a therapeutic option for these patients.
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Affiliation(s)
- Dorothee Atzler
- Department of Cardiovascular Medicine, University of Oxford, United Kingdom German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Christina Baum
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Keller
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany German Center for Cardiovascular Research (DZHK), Partner Site Rhein/Main, Germany
| | - Kathrin Cordts
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Renate B Schnabel
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chi-un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl J Lackner
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein/Main, Germany Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein/Main, Germany Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rainer H Böger
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Edzard Schwedhelm
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Zeller
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
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Nickel CH, Messmer AS, Ghanim L, Ilsemann-Karakoumis J, Giersdorf S, Hertel S, Ernst S, Geigy N, Bingisser R. Adrenomedullin for Risk Stratification of Emergency Patients With Nonspecific Complaints: An Interventional Multicenter Pilot Study. Medicine (Baltimore) 2016; 95:e2395. [PMID: 26735540 PMCID: PMC4706260 DOI: 10.1097/md.0000000000002395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Patients with nonspecific complaints (NSC) presenting to the emergency department (ED) are at risk of life-threatening conditions. New stress biomarkers such as the midregional portion of adrenomedullin (MR-proADM) promise to support decision-making. This study tested the following hypotheses: biomarker-assisted disposition of patients with NSC will not increase mortality. Second, discharge from the ED will increase if clinical risk assessment is combined with low MR-proADM levels. Third, inappropriate disposition to a lower level of care will decrease, if clinical assessment is combined with high MR-proADM levels, and fourth that this algorithm is feasible in the ED setting. Prospective, multicenter, randomized, controlled interventional feasibility study with a 30-day follow-up, including patients with NSC. Patients were randomly assigned to either the standard group (decision-making solely based on clinical assessment) or the Novum group (biomarker-assisted). Regarding disposition, patients were assigned to 1 of 3 risk classes: high-risk (admission to hospital), intermediate risk (community geriatric hospital), and low-risk patients (discharge). In the Novum group, in addition to clinical risk assessment, the information of the MR-proADM level was used. Unless there were overruling criteria, patients were transferred or discharged according to the risk assessment. Primary endpoint was 30-day mortality. Secondary endpoints were comparisons of patient disposition and related mortality rates, ED, and hospital length of stay and readmission. The final study cohort consisted of 398 patients (210 in the Standard group and 188 in the Novum group). Overruling, that is, disposition not according to the result of the proposed algorithm occurred in 51 cases. Baseline characteristics between Standard and Novum groups were similar. The mortality rate in the Novum group was 4.3%, as compared to the Standard group mortality of 6.2%, which was not significantly different (intention-to treat analysis). This was confirmed by the perprotocol analysis as well as by sensitivity analysis. For the secondary endpoints, no significant differences were detected. Biomarker-assisted disposition is safe in patients with NSC. Discharge rates did not increase. Feasibility could only partly be shown due to an unexpectedly high overruling rate. Inappropriate disposition to lower levels of care did not change. ClinicalTrials. gov Identifier: NCT00920491.
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Affiliation(s)
- Christian Hans Nickel
- From the Emergency Department, University Hospital, Basel (CHN, ASM, LG, JI-K, RB); Emergency Department, Kantonsspital Baselland, Liestal, Switzerland (NG); Research Department, Thermo Scientific Biomarkers, Hennigsdorf, Germany (SG, SH); and Emergency Department, Kantonsspital Olten, Olten, Switzerland (SE)
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Associations of circulating natriuretic peptides with haemodynamics in precapillary pulmonary hypertension. Respir Med 2015; 109:1213-23. [PMID: 26194624 DOI: 10.1016/j.rmed.2015.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/09/2015] [Accepted: 02/23/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND While N-terminal B-type natriuretic peptide (NT-proBNP) has been examined extensively in pulmonary hypertension (PH), limited data exists on the subtype A, C and D. The aim of this prospective pilot study was a head-to-head comparison of NPs in respect to haemodynamic parameters and the influence of renal function. METHODS Plasma samples were drawn during routine right heart catheterization in 62 patients with precapillary PH and 20 control patients. MR-proANP measurements were performed on the automated Kryptor platform, NT-proBNP by CLIA, NT-proCNP and DNP levels by ELISA. Results are expressed as median [range] and tested non-parametrically. Non-parametric locally linear multiple regression was performed to determine the influence of renal function on NP levels. P-values <0.05 were considered significant. RESULTS Patients with PH had significantly higher MR-proANP and NT-proBNP levels. NT-proCNP showed a trend to higher levels, while DNP did not differ from control subjects. Both MR-proANP and NT-proBNP were associated with cardiac index (CI), right atrial pressure (RAP), mean pulmonary artery pressure (PAPm) and pulmonary vascular resistance index (PVRI). NT-proCNP was associated with RAP, while DNP showed no associations with haemodynamic variables. Associations of haemodynamic parameters with NPs were weakened in patients with in elevated serum creatinine and showed increased regression slopes. CONCLUSION MR-proANP demonstrated equivalent associations with haemodynamics compared to NT-proBNP, but both markers depend on intact renal function. NT-proCNP was correlated with RAP and renal function, while DNP showed no associations. Larger studies should evaluate MR-proANP as candidate prognostic biomarker in PH.
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28
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Yuyun MF, Narayan HK, Ng LL. Prognostic significance of adrenomedullin in patients with heart failure and with myocardial infarction. Am J Cardiol 2015; 115:986-91. [PMID: 25682438 DOI: 10.1016/j.amjcard.2015.01.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 02/02/2023]
Abstract
We undertook this systematic review to determine the prognostic significance of adrenomedullin (ADM) in patients with heart failure and acute myocardial infarction (AMI). Given the difficulty in measuring mature ADM, its surrogate, midregional proadrenomedullin (MRproADM) has been used in most studies. Systematic search of original published studies through MEDLINE and the Cochrane Collaboration databases restricted to reports in English from January 1, 1993, to June 30, 2014, in humans was undertaken. Heterogeneity of studies prohibited a meta-analysis. In patients with heart failure, the area under the curve for prediction of mortality by MRproADM ranged from 0.68 to 0.81 (95% confidence intervals [CI] 0.63 to 0.91) across studies. One nmol/l increase in MRproADM was associated with hazard ratios (HRs) ranging from 1.77 to 2.79 (95% CI 1.29 to 5.95) for death in patients with heart failure. In patients with AMI, the area under the curve for MRproADM predicting MACE ranged from 0.64 to 0.80 (CI 0.51 to 0.87) across studies and death 0.79 to 0.84 (CI 0.73 to 0.90). One nmol/l increase in MRproADM was associated with HR for MACE ranging from 1.78 to 4.10 (CI 1.20 to 10.12), whereas log10 of MRproADM had HRs of 3.63 to 9.75 (CI 1.48 to 26.16) for MACE and 4.86 to 16.68 (CI 4.56 to 60.99) for death across studies in patients with AMI. In conclusion, adrenomedullin is an independent predictor of death in patients with heart failure and of MACE and death in patients who have suffered an AMI. Quantification of this peptide might contribute to improved risk stratification in settings of heart failure and myocardial infarction.
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Affiliation(s)
- Matthew F Yuyun
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
| | - Hafid K Narayan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; Department of Cardiovascular Sciences, National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; Department of Cardiovascular Sciences, National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
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29
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Resl M, Vila G, Grimm G, Heinisch B, Riedl M, Dieplinger B, Mueller T, Luger A, Clodi M. Effects of B-type natriuretic peptide on cardiovascular biomarkers in healthy volunteers. J Appl Physiol (1985) 2015; 118:395-9. [DOI: 10.1152/japplphysiol.00101.2014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Cardiovascular biomarkers provide independent prognostic information in the assessment of mortality and cardiovascular complications. However, little is known about possible interactions between these biomarkers. In the present study, we evaluated the influence of B-type natriuretic peptide (BNP) on midregional-proadrenomedullin (MR-proADM), C-terminal-proendothelin-1 (CT-proET-1), growth differentiation factor-15 (GDF-15), midregional-proatrial natriuretic peptide (MR-proANP), copeptin, and procalcitonin in healthy volunteers. Ten healthy male subjects (mean age 24 yr) participating in a randomized, placebo-controlled, single-blinded crossover study received placebo or 3.0 pmol·kg−1·min−1human BNP 32 during a continuous infusion lasting for 4 h. Effects of BNP on other cardiovascular biomarkers were assessed. BNP did not change concentrations of MR-proADM, copeptin, CT-proET1, GDF-15, or procalcitonin. In contrast, MR-proANP was significantly decreased during BNP infusion. BNP as an established cardiovascular biomarker did not affect plasma concentrations of other cardiovascular biomarkers in a model of healthy volunteers.
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Affiliation(s)
- M. Resl
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine, Konventhospital Barmherzige Brueder, Linz, Austria
| | - G. Vila
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - G. Grimm
- Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - B. Heinisch
- Department of Internal Medicine III, Division of Gastroenterology, Medical University of Vienna, Vienna, Austria
| | - M. Riedl
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - B. Dieplinger
- Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Linz, Austria; and
| | - T. Mueller
- Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Linz, Austria; and
| | - A. Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - M. Clodi
- Department of Internal Medicine, Konventhospital Barmherzige Brueder, Linz, Austria
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Kristen AV, Biener M, Hegenbart U, Hardt S, Schnabel PA, Röcken C, Schonland SO, Katus HA, Giannitsis E. Evaluation of the clinical use of midregional pro-atrial natriuretic peptide (MR-proANP) in comparison to N-terminal pro-B-type natriuretic peptide (NT-proBNP) for risk stratification in patients with light-chain amyloidosis. Int J Cardiol 2014; 176:1113-5. [PMID: 25115253 DOI: 10.1016/j.ijcard.2014.07.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 07/13/2014] [Accepted: 07/26/2014] [Indexed: 01/15/2023]
Affiliation(s)
- Arnt V Kristen
- Department of Cardiology, Angiology, and Respiratory Medicine, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Moritz Biener
- Department of Cardiology, Angiology, and Respiratory Medicine, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Ute Hegenbart
- Department of Haematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Stefan Hardt
- Department of Cardiology, Angiology, and Respiratory Medicine, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Philipp A Schnabel
- Institute of Pathology, Heidelberg University, Im Neuenheimer Feld 220/221, D-69120 Heidelberg, Germany
| | - Christoph Röcken
- Institute of Pathology, Kiel University, Arnold-Heller-Straße 3/14, D-24105 Kiel, Germany
| | - Stefan O Schonland
- Department of Haematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Respiratory Medicine, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology, and Respiratory Medicine, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
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31
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Beygui F, Wild PS, Zeller T, Germain M, Castagné R, Lackner KJ, Münzel T, Montalescot G, Mitchell GF, Verwoert GC, Tarasov KV, Trégouët DA, Cambien F, Blankenberg S, Tiret L. Adrenomedullin and arterial stiffness: integrative approach combining monocyte ADM expression, plasma MR-Pro-ADM, and genome-wide association study. ACTA ACUST UNITED AC 2014; 7:634-41. [PMID: 25053723 DOI: 10.1161/circgenetics.113.000456] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adrenomedullin (ADM) is a circulating vasoactive peptide involved in vascular homeostasis and endothelial function. Single nucleotide polymorphisms of the ADM gene are associated with blood pressure variability, and elevated levels of plasma midregional proadrenomedullin (MR-pro-ADM) are associated with cardiovascular diseases. METHODS AND RESULTS We investigated the sources of variability of ADM gene expression and plasma MR-pro-ADM concentrations in the general population, and their relationship with markers of atherosclerosis. MR-pro-ADM levels were assessed in 4155 individuals who underwent evaluation of carotid intima-media thickness and arterial rigidity (reflection index and stiffness index). In a subsample of 1372 individuals, ADM gene expression was assessed as part of a transcriptomic study of circulating monocytes. Nongenetic factors explained 45.8% and 7.5% of MR-pro-ADM and ADM expression variability, respectively. ADM expression correlated with plasma C-reactive protein, interleukin-receptor 1A, and myeloperoxidase, whereas MR-pro-ADM levels correlated with C-terminal proendothelin-1, creatinine, and N-terminal pro-B-type natriuretic peptide. Genome-wide association study of ADM expression and MR-pro-ADM levels both identified a single locus encompassing the ADM gene. ADM expression was associated with 1 single nucleotide polymorphism rs11042717 (P=2.36×10(-12)), whereas MR-pro-ADM was associated with 2 single nucleotide polymorphisms with additive effects, rs2957692 (P=1.54×10(-13)) and rs2957717 (P=4.24×10(-8)). Reflection index was independently associated with rs11042717 (P<10(-4)) and ADM expression (P=0.0002) but not with MR-pro-ADM. Weaker associations were observed for stiffness index. Intima-media thickness was not related to ADM single nucleotide polymorphisms or expression. CONCLUSIONS These results support an involvement of the ADM gene in the modulation of peripheral vascular tone.
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Affiliation(s)
- Farzin Beygui
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - Philipp S Wild
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - Tanja Zeller
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - Marine Germain
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - Raphaele Castagné
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - Karl J Lackner
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - Thomas Münzel
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - Gilles Montalescot
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - Gary F Mitchell
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - Germaine C Verwoert
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - Kirill V Tarasov
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - David-Alexandre Trégouët
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - François Cambien
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.)
| | - Stefan Blankenberg
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.).
| | - Laurence Tiret
- From UMR_S 1166, Sorbonne Universités UPMC Université Paris 06, UMR_S 1166 INSERM, UMR_S 1166 ICAN Institute for Cardiometabolism and Nutrition, Paris, France (F.B., M.G., R.C., G.M., D.-A.T., F.C., L.T.); Department of Cardiology, Caen University Hospital, Caen, France (F.B.); Department of Medicine II (P.S.W., T.M.), Center for Thrombosis and Hemostasis (P.S.W.), Institute for Clinical Chemistry and Laboratory Medicine (K.J.L.), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany (T.Z., S.B.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (ACTION Group, AP-HP, Université Paris 6), Paris, France (G.M.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (G.C.V.); and Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD (K.V.T.).
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Lindberg S, Jensen JS, Pedersen SH, Galatius S, Goetze JP, Mogelvang R. MR-proANP improves prediction of mortality and cardiovascular events in patients with STEMI. Eur J Prev Cardiol 2014; 22:693-700. [PMID: 24906365 DOI: 10.1177/2047487314538856] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/18/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Atrial natriuretic peptide (ANP) is released from the atria (on cleavage of proANP) in response to elevated intra-atrial pressure and wall stretch. Clinical data on proANP are still limited, mainly due to limitations in assaying the protein, which recently have been solved. ProANP is elevated in cardiovascular disease and predicts outcome in heart failure. However, knowledge of the prognostic value in acute myocardial infarction remains limited. METHODS We prospectively included 680 patients with STEMI treated with primary-PCI, from September 2006 to December 2008. Blood samples were drawn immediately before PCI. Plasma MR-proANP was measured using an automated processing assay. Endpoints were all-cause mortality (n = 137) and the combined endpoint (n = 170) of major adverse cardiovascular events (MACE) defined as cardiovascular mortality and admission due to recurrent MI, ischaemic stroke or heart failure. RESULTS During 5-year follow-up, MR-proANP was associated with increased risk of all-cause mortality and MACE (both p < 0.001). After adjustment for confounding risk factors (age, gender, hypertension, diabetes, hypercholesterolaemia, smoking, previous MI, BMI, eGFR, CRP, peak-TnI, symptom-to-balloon time, multivessel disease, complex lesion, LAD-lesion and use of glycoprotein inhibitor), MR-proANP remained an independent predictor of all-cause mortality and MACE - hazard ratio: 1.68 (95% CI 1.35-2.10; p < 0.001) and 1.68 (95% CI 1.39-2.03; p < 0.001) per standard deviation increase in MR-proANP. MR-proANP significantly increased C-statistics and reclassified 26% of the patients for all-cause mortality and 34% for MACE into higher or lower risk categories, matching actual event rates more accurately. CONCLUSIONS Plasma MR-proANP independently predicts all-cause mortality and MACE in patients with STEMI.
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Affiliation(s)
- Søren Lindberg
- Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark
| | - Jan Skov Jensen
- Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Sune H Pedersen
- Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark
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Filippatos G, Farmakis D, Parissis J. Novel biomarkers in acute coronary syndromes: new molecules, new concepts, but what about new treatment strategies? J Am Coll Cardiol 2014; 63:1654-6. [PMID: 24530662 DOI: 10.1016/j.jacc.2013.11.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022]
Affiliation(s)
| | - Dimitrios Farmakis
- Department of Cardiology, Athens University Hospital Attikon, Athens, Greece
| | - John Parissis
- Department of Cardiology, Athens University Hospital Attikon, Athens, Greece
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Pedowska-Włoszek J, Kostrubiec M, Kurnicka K, Ciurzynski M, Palczewski P, Pruszczyk P. Midregional proadrenomedullin (MR-proADM) in the risk stratification of patients with acute pulmonary embolism. Thromb Res 2013; 132:506-10. [DOI: 10.1016/j.thromres.2013.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/10/2013] [Accepted: 08/12/2013] [Indexed: 11/16/2022]
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