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Azarsiz E, Karaca N, Kutukculer N. Mid-Regional Proadrenomedullin Levels in Primary Immunodeficiencies Complicated with Pulmonary Manifestations. Indian J Clin Biochem 2023; 38:475-484. [PMID: 37746537 PMCID: PMC10516846 DOI: 10.1007/s12291-022-01061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/15/2022] [Indexed: 10/14/2022]
Abstract
The development of lower respiratory complications in children with primary immunodeficiencies characterized by recurrent infections significantly contributes to morbidity and mortality. This is clinically more important and specific in the evaluation of prognosis. The inflammatory response that develops throughout the clinical process can cause the release of several biomarkers. This study aimed to evaluate the inflammatory biomarker "mid-regional pro-adrenomedullin (MR-proADM)" levels by distribution of lower respiratory tract complications. Plasma MR-proADM levels were measured in children with (n = 52) and without (n = 103) lower respiratory tract complications. The complicated group was also evaluated as "infective and non-infective" groups. The median MR-proADM levels were higher in the complicated cases (p = 0.175). It was 205.5 (73.4- 562.6) ng/L in the infective group while it was 96.1 (26.1-43.3) ng/L in the non-infective group and the difference between the two groups was statistically significant (p = 0.003). The predictive value of MR-proADM (AUC = 0.749, p = 0.003) was statistically significant compared to CRP (AUC = 0.330, p = 0.040) and SAA (AUC = 0.261, p = 0.004) in the infective group. This study evidences that the MR-proADM levels are higher in PID cases with infective pulmonary complications. Among other markers, MR-proADM appears to be a particularly good predictive inflammation marker for these children. Supplementary Information The online version contains supplementary material available at 10.1007/s12291-022-01061-9.
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Affiliation(s)
- Elif Azarsiz
- Department of Clinical Biochemistry, Ege University Faculty of Medicine, 35040 Bornova- Izmir, Turkey
| | - Neslihan Karaca
- Department of Pediatric Immunology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Necil Kutukculer
- Department of Pediatric Immunology, Ege University Faculty of Medicine, Izmir, Turkey
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2
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Thupakula S, Nimmala SSR, Ravula H, Chekuri S, Padiya R. Emerging biomarkers for the detection of cardiovascular diseases. Egypt Heart J 2022; 74:77. [PMID: 36264449 PMCID: PMC9584006 DOI: 10.1186/s43044-022-00317-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background The prevalence of cardiovascular disease (CVD) has been continuously increasing, and this trend is projected to continue. CVD is rapidly becoming a significant public health issue. Every year there is a spike in hospital cases of CVD, a critical health concern in lower- and middle-income countries. Based on identification of novel biomarkers, it would be necessary to study and evaluate the diagnostic requirements or CVD to expedite early detection. Main body The literature review was written using a wide range of sources, such as well-known medical journals, electronic databases, manuscripts, texts, and other writings from the university library. After that, we analysed the specific markers of CVD and compiled a systematic review. A growing body of clinical research aims to identify people who are at risk for cardiovascular disease by looking for biomolecules. A small number of biomarkers have been shown to be useful and reliable in medicine. Biomarkers can be used for a variety of clinical applications, such as predicting heart disease risk, diagnosing disease, or predicting outcomes. As a result of the ability for a single molecule to act as a biomarker, its usefulness in medicine is expected to increase significantly. Conclusions Based on assessing the current trends in the application of CVD markers, we discussed and described the requirements for the application of CVD biomarkers in coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other cardiovascular illnesses. Furthermore, the current review focuses on biomarkers for CVD and the procedures that should be considered to establish the comprehensive nature of the expression of biomarkers for cardiovascular illness.
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Affiliation(s)
- Sreenu Thupakula
- grid.412419.b0000 0001 1456 3750Department of Biochemistry, Osmania University, Amberpet, Hyderabad, Telangana 500007 India
| | - Shiva Shankar Reddy Nimmala
- grid.412419.b0000 0001 1456 3750Department of Biochemistry, Osmania University, Amberpet, Hyderabad, Telangana 500007 India
| | - Haritha Ravula
- grid.18048.350000 0000 9951 5557Department of Plant Sciences, University of Hyderabad, Gopanpalle, Hyderabad, Telangana 500019 India
| | - Sudhakar Chekuri
- grid.412419.b0000 0001 1456 3750Department of Genetics, Osmania University, Amberpet, Hyderabad, Telangana 500007 India
| | - Raju Padiya
- grid.412419.b0000 0001 1456 3750Department of Biochemistry, Osmania University, Amberpet, Hyderabad, Telangana 500007 India
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3
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Potier L, Mohammedi K, Saulnier PJ, Fumeron F, Halimi JM, Venteclef N, Marre M, Hadjadj S, Roussel R, Velho G. Plasma Adrenomedullin, Allelic Variations in the ADM Gene, and Risk for Lower-Limb Amputation in People With Type 2 Diabetes. Diabetes Care 2022; 45:1631-1639. [PMID: 35583678 DOI: 10.2337/dc21-2638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/08/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients with diabetes have an increased risk for lower-limb amputation (LLA), but biomarkers to assess risk of LLA are lacking. Adrenomedullin (ADM) is a vasodilator peptide that also plays a role in fluid and electrolyte homeostasis in the kidney, increasing natriuresis and diuresis. ADM was shown to be associated with cardiovascular and renal events in diabetes, but it was not investigated in terms of LLA risk. We investigated the hypothesis that ADM is associated with LLA in people with type 2 diabetes. RESEARCH DESIGN AND METHODS We studied 4,375 participants in the DIABHYCAR and SURDIAGENE cohorts (men, 68%; mean 66 years of age; mean duration of diabetes 12 years; and median follow-up 5.3 years). Plasma midregional proadrenomedullin (MR-proADM; a surrogate for ADM) was measured by immunofluorescence. Five single nucleotide polymorphisms (SNPs) in the ADM gene region were genotyped. RESULTS LLA requirement during follow-up by increasing tertiles of plasma MR-proADM distribution was 1.0% (tertile 1 [T1]), 2.3% (T2), and 4.4% (T3) (P < 0.0001). In Cox multivariate analysis, the adjusted hazard ratio (95% CI) for LLA was 4.40 (2.30-8.88) (P < 0.0001) for T3 versus T1. Moreover, MR-proADM significantly improved indices for risk stratification of LLA. Four SNPs were associated with plasma MR-proADM concentration at baseline and with LLA during follow-up. Alleles associated with higher MR-proADM were associated with increased LLA risk. CONCLUSIONS We observed associations of plasma MR-proADM with LLA and of ADM SNPs with plasma MR-proADM and with LLA in people with type 2 diabetes. This pattern of Mendelian randomization supports the causality of the association of ADM with LLA.
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Affiliation(s)
- Louis Potier
- Institut Necker-Enfants Malades, INSERM, Université de Paris, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kamel Mohammedi
- Bordeaux University and Hospital, INSERM U1034, Bordeaux, France
| | - Pierre-Jean Saulnier
- Centre d'Investigation Clinique CIC 1402, INSERM, Université de Poitiers, CHU Poitiers, Poitiers, France
| | - Frédéric Fumeron
- Institut Necker-Enfants Malades, INSERM, Université de Paris, Paris, France
| | - Jean-Michel Halimi
- CHU de Tours, Service Néphrologie, Dialyse et Transplantation, Tours, France.,INSERM CIC 0202, Tours, France
| | - Nicolas Venteclef
- Institut Necker-Enfants Malades, INSERM, Université de Paris, Paris, France
| | - Michel Marre
- Institut Necker-Enfants Malades, INSERM, Université de Paris, Paris, France.,Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Samy Hadjadj
- Institut du Thorax, INSERM, CNRS, Université Nantes, CHU Nantes, Nantes, France
| | - Ronan Roussel
- Institut Necker-Enfants Malades, INSERM, Université de Paris, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilberto Velho
- Institut Necker-Enfants Malades, INSERM, Université de Paris, Paris, France
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4
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Iwao M, Tanaka R, Suzuki Y, Nakata T, Aoki K, Fukuda A, Fukunaga N, Tatsuta R, Ohno K, Shibata H, Itoh H. Association between MR-proADM concentration and treatment intensity of antihypertensive agents in chronic kidney disease patients with insufficient blood pressure control. Sci Rep 2021; 11:21931. [PMID: 34754024 PMCID: PMC8578546 DOI: 10.1038/s41598-021-01403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/07/2021] [Indexed: 11/09/2022] Open
Abstract
Response to antihypertensive drugs in patients with chronic kidney disease (CKD) has great interindividual variability. Adrenomedullin (ADM) is produced abundantly in hypertension, but clearance is very rapid. Mid-regional proADM (MR-proADM) produced from an ADM precursor is considered a surrogate biomarker for quantification of ADM. We investigated the association of MR-proADM with antihypertensive resistance in CKD patients with poor blood pressure (BP) control. This cross-sectional study analyzed 33 CKD patients with poor BP control defined as failure to achieve target BP despite at least two classes of antihypertensive drugs. Treatment intensity score was calculated to facilitate comparability of antihypertensive regimens across subjects taking different drugs. Plasma MR-proADM concentration was measured using ultra-performance liquid chromatography coupled with tandem mass spectrometry. Plasma MR-proADM concentration correlated with estimated glomerular filtration rate (eGFR) (r = - 0.777, p < 0.001). Treatment intensity score correlated positively with plasma MR-proADM concentration (r = 0.355, p = 0.043), and the correlation was further enhanced after correction by weight (r = 0.538, p = 0.001). Single and multiple regression analysis identified MR-proADM concentration (p = 0.005) as independently associated with weight-corrected treatment intensity score. MR-proADM may be useful as a biomarker to determine the therapeutic intensity of antihypertensive drugs in CKD patients with poor BP control.
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Affiliation(s)
- Motoshi Iwao
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan.
| | - Yosuke Suzuki
- Department of Medication Use Analysis and Clinical Research, Meiji Pharmaceutical University, Noshio, Tokyo, Japan
| | - Takeshi Nakata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Hasama-machi, Oita, Japan
| | - Kohei Aoki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Hasama-machi, Oita, Japan
| | - Akihiro Fukuda
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Hasama-machi, Oita, Japan
| | - Naoya Fukunaga
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Hasama-machi, Oita, Japan
| | - Ryosuke Tatsuta
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
| | - Keiko Ohno
- Department of Medication Use Analysis and Clinical Research, Meiji Pharmaceutical University, Noshio, Tokyo, Japan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Hasama-machi, Oita, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
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Koyama T, Kuriyama N, Suzuki Y, Saito S, Tanaka R, Iwao M, Tanaka M, Maki T, Itoh H, Ihara M, Shindo T, Uehara R. Mid-regional pro-adrenomedullin is a novel biomarker for arterial stiffness as the criterion for vascular failure in a cross-sectional study. Sci Rep 2021; 11:305. [PMID: 33431996 PMCID: PMC7801498 DOI: 10.1038/s41598-020-79525-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023] Open
Abstract
We investigated the potential of mid-regional pro-adrenomedullin (MR-proADM) for use as a novel biomarker for arterial stiffness as the criterion for vascular failure and cardiometabolic disease (obesity, hypertension, dyslipidemia, diabetes, and metabolic syndrome) compared with high-sensitivity C-reactive protein (hsCRP). Overall, 2169 individuals (702 men and 1467 women) were enrolled. Multiple regression analysis was performed to assess the association of MR-proADM and hsCRP with brachial-ankle pulse wave velocity (baPWV), adjusting for other variables. The diagnostic performance (accuracy) of MR-proADM with regard to the index of vascular failure was tested with the help of receiver operating characteristic curve analysis in the models. MR-proADM was significantly higher in participants with vascular failure, as defined by baPWV and/or its risk factors (obesity, hypertension, dyslipidemia, diabetes, and metabolic syndrome), than in control groups. Independent of cardiovascular risk factors (age, drinking, smoking, body mass index, systolic blood pressure, lipid and glycol metabolism), MR-proADM was significantly associated with baPWV, and MR-proADM showed higher areas under the curve of baPWV than hsCRP showed. MR-proADM is more suitable for the diagnosis of higher arterial stiffness as the criterion for vascular failure than hsCRP. Because vascular assessment is important to mitigate the most significant modifiable cardiovascular risk factors, MR-proADM may be useful as a novel biomarker on routine blood examination.
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Affiliation(s)
- Teruhide Koyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Nagato Kuriyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yosuke Suzuki
- Department of Medication Use Analysis and Clinical Research, Meiji Pharmaceutical University, Kiyose, Japan.,Department of Clinical Pharmacy, Oita University Hospital, Oita, Japan
| | - Satoshi Saito
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Oita, Japan
| | - Motoshi Iwao
- Department of Clinical Pharmacy, Oita University Hospital, Oita, Japan
| | - Megumu Tanaka
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Department of Life Innovation, Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Matsumoto, Japan
| | - Takakuni Maki
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Oita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takayuki Shindo
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Department of Life Innovation, Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Matsumoto, Japan
| | - Ritei Uehara
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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6
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Josiassen J, Frydland M, Holmvang L, Lerche Helgestad OK, Okkels Jensen L, Goetze JP, Eifer Møller J, Hassager C. Mortality in cardiogenic shock is stronger associated to clinical factors than contemporary biomarkers reflecting neurohormonal stress and inflammatory activation. Biomarkers 2020; 25:506-512. [PMID: 32649233 DOI: 10.1080/1354750x.2020.1795265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To validate the IABP-SHOCK II risk score in a Danish cohort and assess the association between the IABP-SHOCK II risk score and admission concentration of biomarkers reflecting neurohormonal - (Copeptin, Pro-atrial natriuretic peptide (proANP), Mid-regional pro-adrenomedullin (MRproADM)) and inflammatory (ST2) activation in patients with CS complicating ST segment elevation myocardial infarction (STEMI). METHODS A total of 137 consecutive patients admitted with STEMI and CS at two tertiary heart centres were stratified according to the IABP-SHOCK II risk score (0-2; 3/4; 5-9), and had blood sampled upon admission. RESULTS Plasma concentrations of Copeptin (median (pmol/L) score 0-2: 313; score 3/4: 682; score 5-9: 632 p < 0.0001), proANP (pmol/L) (1459; 2225; 2876 p = 0.0009) and MRproADM (nmol/L) (0.86; 1.2; 1.4 p = 0.04) were significantly associated with the risk score, whereas ST2 (ng/mL) was not (44; 60; 45 p = 0.23). The IABP-SHOCK II risk score predicted 30-day mortality (score 0-2: 22%; score 4/3: 51%; score 5-9: 72%, area under the curve (AUC): 0.73, plogrank < 0.0001), while the tested biomarkers did not (AUC: 0.51<plogrank < 0.57). CONCLUSION Plasma concentrations of Copeptin, MRproADM and proANP were associated with the IABP-SHOCK II risk score in STEMI patients admitted with CS. The risk score predicted 30-day mortality, with no improvement in prediction when concentrations of the assessed biomarkers were added.
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Affiliation(s)
- Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Martin Frydland
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jens Peter Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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Giurgea GA, Zlabinger K, Gugerell A, Lukovic D, Syeda B, Mandic L, Pavo N, Mester-Tonczar J, Traxler-Weidenauer D, Spannbauer A, Kastner N, Müller C, Anvari A, Bergler-Klein J, Gyöngyösi M. Multimarker Approach to Identify Patients with Coronary Artery Disease at High Risk for Subsequent Cardiac Adverse Events: The Multi-Biomarker Study. Biomolecules 2020; 10:biom10060909. [PMID: 32549327 PMCID: PMC7356937 DOI: 10.3390/biom10060909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Abstract
In our prospective non-randomized, single-center cohort study (n = 161), we have evaluated a multimarker approach including S100 calcium binding protein A12 (S100A1), interleukin 1 like-receptor-4 (IL1R4), adrenomedullin, copeptin, neutrophil gelatinase-associated lipocalin (NGAL), soluble urokinase plasminogen activator receptor (suPAR), and ischemia modified albumin (IMA) in prediction of subsequent cardiac adverse events (AE) during 1-year follow-up in patients with coronary artery disease. The primary endpoint was to assess the combined discriminatory predictive value of the selected 7 biomarkers in prediction of AE (myocardial infarction, coronary revascularization, death, stroke, and hospitalization) by canonical discriminant function analysis. The main secondary endpoints were the levels of the 7 biomarkers in the groups with/without AE; comparison of the calculated discriminant score of the biomarkers with traditional logistic regression and C-statistics. The canonical correlation coefficient was 0.642, with a Wilk’s lambda value of 0.78 and p < 0.001. By using the calculated discriminant equation with the weighted mean discriminant score (centroid), the sensitivity and specificity of our model were 79.4% and 74.3% in prediction of AE. These values were higher than that of the calculated C-statistics if traditional risk factors with/without biomarkers were used for AE prediction. In conclusion, canonical discriminant analysis of the multimarker approach is able to define the risk threshold at the individual patient level for personalized medicine.
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Affiliation(s)
- Georgiana-Aura Giurgea
- Department of Angiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria;
| | - Katrin Zlabinger
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Alfred Gugerell
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Dominika Lukovic
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Bonni Syeda
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Ljubica Mandic
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Noemi Pavo
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Julia Mester-Tonczar
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Denise Traxler-Weidenauer
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Andreas Spannbauer
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Nina Kastner
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Claudia Müller
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Anahit Anvari
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Jutta Bergler-Klein
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
| | - Mariann Gyöngyösi
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (K.Z.); (A.G.); (D.L.); (B.S.); (L.M.); (N.P.); (J.M.-T.); (D.T.-W.); (A.S.); (N.K.); (C.M.); (A.A.); (J.B.-K.)
- Correspondence: ; Tel.: +43-1-40400-46140
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8
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Pek JH, Fook-Chong SMC, Choo JCJ, Tan CHC, Lin Z, Chan CM, Yeo CP, Lim SH. Copeptin, myeloperoxidase and pro-adrenomedullin for acute coronary syndrome in patients with chronic kidney disease. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105819843927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives:Copeptin, myeloperoxidase and pro-adrenomedullin have emerged as potential biomarkers for diagnosis and prognosis of acute coronary syndrome (ACS). However, their applicability in patients with chronic kidney disease (CKD) remains unknown as these patients were excluded from previous studies. Our objective was to determine the superior novel cardiac marker to predict 30-day and six-month adverse cardiac events (ACEs) defined as cardiac-related death, myocardial infarction and ventricular fibrillation.Methods:A prospective observational study was carried out. Patients were included if they presented to the emergency department with symptoms suggestive of ACS and had CKD as defined as a serum creatinine of more than 130 µmol/l. Copeptin, myeloperoxidase and pro-adrenomedulin assays were performed. Occurrence of ACE was traced from review of the patients’ case records and the registry of deaths.Results:A total of 724 patients were recruited: 60.6% were male and 68.6% were Chinese. The median age was 67 years. Among those recruited, 88.3% had CKD stages 4 and 5, with 33.5% on dialysis. The rates of ACE at 30 days and six months were 15.1% and 21.7%, respectively. All readings of the three biomarkers were not significantly different in patients with ACE compared with those without both at 30 days and six months. The areas under the curve for copeptin, myeloperoxidase and pro-adrenomedullin were 0.53, 0.50 and 0.45, respectively ( p > 0.05).Conclusions:The poor performance of the biomarkers may be attributable to lack of specificity for ACS, as elevated levels could be from other causes in CKD patients. Routine testing cannot be recommended.
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Affiliation(s)
- Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | | | | | - Carol Hui Chen Tan
- Department of Clinical Biochemistry, Singapore General Hospital, Singapore
| | - Ziwei Lin
- Department of Emergency Medicine, National University Hospital, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Chin Pin Yeo
- Department of Clinical Pathology, Singapore General Hospital, Singapore
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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9
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Krintus M, Kozinski M, Braga F, Kubica J, Sypniewska G, Panteghini M. Plasma midregional proadrenomedullin (MR-proADM) concentrations and their biological determinants in a reference population. Clin Chem Lab Med 2019; 56:1161-1168. [PMID: 29432202 DOI: 10.1515/cclm-2017-1044] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/18/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Midregional proadrenomedullin (MR-proADM) is emerging as a prognostic biomarker for detecting the failure of multiple organs. Establishment of scientifically robust reference intervals facilitates interpretation of laboratory test results. The objectives of this study were (i) to establish reliable reference intervals for plasma MR-proADM using a commercially available automated fluoroimmunoassay in apparently healthy individuals, and (ii) to identify biological determinants of MR-proADM concentrations. METHODS A total of 506 questionnaire-identified apparently healthy adults were enrolled in a single-center, cross-sectional study. A final reference group (n=172) was selected after exclusion of obese individuals, those with increased values of laboratory biomarkers indicating asymptomatic myocardial injury or dysfunction, ongoing inflammation, diabetes, dyslipidemia and renal dysfunction and outliers. RESULTS The 2.5th and 97.5th percentile intervals for MR-proADM values in the reference group (90% confidence interval) were 0.21 (0.19-0.23) and 0.57 (0.55-0.59) nmol/L, respectively. Although older age, higher values of HbA1c, C-reactive protein, B-type natriuretic peptide and body mass index, together with a history of smoking and a decreased estimated glomerular filtration rate were significantly associated with increasing concentrations of MR-proADM in both univariate and multivariate analyses, magnitudes of these relationships were modest and did not substantially influence MR-proADM reference intervals. Sex-dependent difference in MR-proADM reference intervals was not detected [0.19 (0.16-0.22)-0.56 (0.54-0.60) nmol/L in females vs. 0.22 (0.20-0.25)-0.58 (0.57-0.63) nmol/L in males]. CONCLUSIONS Our study successfully established robust reference intervals for MR-proADM concentrations in plasma. Considering the negligible influence of potential biological determinants on plasma MR-proADM, we recommend the adoption of single reference intervals for adult population as a whole.
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Affiliation(s)
- Magdalena Krintus
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland, Phone: +48 52 585 40 23, Fax: +48 52 585 40 24
| | - Marek Kozinski
- Department of Principles of Clinical Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Federica Braga
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Grazyna Sypniewska
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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10
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Fraty M, Velho G, Gand E, Fumeron F, Ragot S, Sosner P, Mohammedi K, Gellen B, Saulnier PJ, Halimi JM, Montaigne D, Ducrocq G, Rehman M, Marre M, Roussel R, Hadjadj S. Prognostic value of plasma MR-proADM vs NT-proBNP for heart failure in people with type 2 diabetes: the SURDIAGENE prospective study. Diabetologia 2018; 61:2643-2653. [PMID: 30232509 DOI: 10.1007/s00125-018-4727-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/03/2018] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS N-terminal pro-B-type natriuretic peptide (NT-proBNP) is the gold standard prognostic biomarker for diagnosis and occurrence of heart failure. Here, we compared its prognostic value for the occurrence of congestive heart failure with that of plasma mid-region pro-adrenomedullin (MR-proADM), a surrogate for adrenomedullin, a vasoactive peptide with vasodilator and natriuretic properties, in people with type 2 diabetes. METHODS Plasma MR-proADM concentration was measured in baseline samples of a hospital-based cohort of consecutively recruited participants with type 2 diabetes. Our primary endpoint was heart failure requiring hospitalisation. RESULTS We included 1438 participants (age 65 ± 11 years; 604 women and 834 men). Hospitalisation for heart failure occurred during follow-up (median 64 months) in 206 participants; the incidence rate of heart failure was 2.5 (95% CI 2.2, 2.9) per 100 person-years. Plasma concentrations of MR-proADM and NT-proBNP were significantly associated with heart failure in a Cox multivariable analysis model when adjusted for age, diabetes duration, history of coronary heart disease, proteinuria and baseline eGFR (adjHR [95%CI] 1.83 [1.51, 2.21] and 2.20 [1.86, 2.61], respectively, per 1 SD log10 increment, both p < 0.001). MR-proADM contributed significant supplementary information to the prognosis of heart failure when we considered the clinical risk factors (integrated discrimination improvement [IDI, mean ± SEM] 0.021 ± 0.007, p = 0.001) (Table 3). Inclusion of NT-proBNP in the multivariable model including MR-proADM contributed significant complementary information on prediction of heart failure (IDI [mean ± SEM] 0.028 ± 0.008, p < 0.001). By contrast, MR-proADM did not contribute supplementary information on prediction of heart failure in a model including NT-proBNP (IDI [mean ± SEM] 0.003 ± 0.003, p = 0.27), with similar results for heart failure with reduced ejection fraction and preserved ejection fraction. CONCLUSIONS/INTERPRETATION MR-proADM is a prognostic biomarker for heart failure in people with type 2 diabetes but gives no significant complementary information on prediction of heart failure compared with NT-proBNP.
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Affiliation(s)
- Mathilde Fraty
- Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France.
- Service d'Endocrinologie-Diabétologie, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France.
| | - Gilberto Velho
- Centre de Recherche des Cordeliers, Inserm UMR_S 1138, Paris, France
| | - Elise Gand
- Pole DUNE (Digestif, Urologie, Néphrologie, Endocrinologie), CHU de Poitiers, Poitiers, France
| | - Fréderic Fumeron
- Centre de Recherche des Cordeliers, Inserm UMR_S 1138, Paris, France
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Stéphanie Ragot
- Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France
- UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
- CIC 1402, Inserm Poitiers, Poitiers, France
| | - Philippe Sosner
- Centre médico-sportif MON STADE, Paris, France
- Centre de Diagnostic et de Thérapeutique, AP-HP Hôpital Universitaire Hôtel-Dieu, Paris, France
- Laboratoire MOVE (EA 6314), Faculté des Sciences du Sport, Université de Poitiers, Poitiers, France
| | - Kamel Mohammedi
- Service Endocrinologie, Diabétologie, Nutrition, Hôpital Haut Lévêque, CHU de Bordeaux, Pessac, France
| | - Barnabas Gellen
- Service de Cardiologie, Polyclinique de Poitiers, Poitiers, France
| | - Pierre-Jean Saulnier
- Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France
- UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
- CIC 1402, Inserm Poitiers, Poitiers, France
| | - Jean-Michel Halimi
- Service Néphrologie, Dialyse et Transplantation, CHU de Tours, Tours, France
- Inserm CIC0202, Tours, France
| | - David Montaigne
- Clinique de Physiologie et Département d'Échocardiographie, CHRU Lille, Lille, France
- Inserm U1011, EGID, Institut Pasteur de Lille, Université de Lille, Lille, France
| | - Grégory Ducrocq
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Service de Cardiologie, AP-HP, Hôpital Bichat Claude Bernard, Paris, France
| | - Michaela Rehman
- Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France
- Service de Cardiologie, CHU de Poitiers, Poitiers, France
| | - Michel Marre
- Centre de Recherche des Cordeliers, Inserm UMR_S 1138, Paris, France
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Service de Diabétologie, Endocrinologie et Nutrition, DHU FIRE, AP-HP, Hôpital Bichat Claude Bernard, Paris, France
| | - Ronan Roussel
- Centre de Recherche des Cordeliers, Inserm UMR_S 1138, Paris, France
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Service de Diabétologie, Endocrinologie et Nutrition, DHU FIRE, AP-HP, Hôpital Bichat Claude Bernard, Paris, France
| | - Samy Hadjadj
- Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France.
- Service d'Endocrinologie-Diabétologie, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France.
- UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France.
- CIC 1402, Inserm Poitiers, Poitiers, France.
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11
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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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12
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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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13
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Golubović M, Janković R, Sokolović D, Ćosić V, Maravić-Stojkovic V, Kostić T, Perišić Z, Lađević N. Preoperative Midregional Pro-Adrenomedullin and High-Sensitivity Troponin T Predict Perioperative Cardiovascular Events in Noncardiac Surgery. Med Princ Pract 2018; 27. [PMID: 29514145 PMCID: PMC6062667 DOI: 10.1159/000488197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE We evaluated the utility of preoperative midregional (MR) pro-adrenomedullin (proADM) and cardiac troponin T (TnT) for improved detection of patients at high risk for perioperative cardiac events and mortality after major noncardiac surgery. SUBJECTS AND METHODS This prospective, single-center, observational study enrolled 79 patients undergoing major noncardiac surgery. After initial clinical assessment (clinical history, physical examination, echocardiogram, blood tests, and chest X-ray), MR-proADM and high-sensitivity TnT (hsTnT) were measured within 48 h prior to surgery by immunoluminometric and electrochemiluminescence immunoassay. Patients were followed by the consulting physician until discharge or up to 14 days in the hospital after surgery. Perioperative cardiac events included myocardial infarction and development or aggravation of congestive heart failure. Data were compared between patients who developed target events and event-free patients. RESULTS Within 14 days of monitoring, 14 patients (17.72%) developed target events: 9 (11.39%) died and 5 (6.33%) developed cardiovascular events. The average age of the patients was 71.29 ± 6.62 years (range: 55-87). Sex, age, and hsTnT did not significantly differ between groups. MR- proADM concentration was higher in deceased patients (p = 0.01). The upper quartile of MR-proADM was associated with a fatal outcome (66.7 vs. 20.0%, p < 0.01) and with cardiovascular events (64.3 vs. 16.9%, p < 0.01). MR-proADM above the cutoff value (≥0.85) was associated with a fatal outcome (88.9 vs. 20.0%, p < 0.01) and cardiovascular events (71.4 vs. 28.6%, p < 0.01); this association was not observed for hsTnT. CONCLUSION Preoperative measurement of MR-proADM provides useful information for perioperative cardiac events in high-risk patients scheduled for noncardiac surgery.
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Affiliation(s)
- Mlađjan Golubović
- Center for Anesthesiology and Reanimatology, Clinical Center Nis, Niš, Serbia
- *Mlađan Golubović, Center for Anesthesiology and Reanimatology, Clinical Center Nis, Grčka 17, RS–18000 Niš (Serbia), E-Mail
| | - Radmilo Janković
- Center for Anesthesiology and Reanimatology, Clinical Center Nis, Niš, Serbia
- Faculty of Medicine, University of Nis, Niš, Serbia
| | | | - Vladan Ćosić
- Center for Biochemistry, Clinical Center Nis, Niš, Serbia
| | | | - Tomislav Kostić
- Faculty of Medicine, University of Nis, Niš, Serbia
- Clinic for Cardiovascular Diseases, Clinical Center Nis, Niš, Serbia
| | - Zoran Perišić
- Faculty of Medicine, University of Nis, Niš, Serbia
- Clinic for Cardiovascular Diseases, Clinical Center Nis, Niš, Serbia
| | - Nebojša Lađević
- Center for Anesthesiology and Reanimatology, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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14
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Odermatt J, Meili M, Hersberger L, Bolliger R, Christ-Crain M, Briel M, Bucher HC, Mueller B, Schuetz P. Pro-Adrenomedullin predicts 10-year all-cause mortality in community-dwelling patients: a prospective cohort study. BMC Cardiovasc Disord 2017; 17:178. [PMID: 28676115 PMCID: PMC5496393 DOI: 10.1186/s12872-017-0605-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/22/2017] [Indexed: 01/20/2023] Open
Abstract
Background Several studies found mid-regional pro-adrenomedullin (ProADM), the prohormone of the cardiovascular protein adrenomedullin, to be strongly associated with short-term mortality, mostly in the inpatient setting. We evaluated associations of ProADM levels with 10-year mortality in community-dwelling primary care patients with respiratory tract infections. Methods This is a post-hoc analysis using clinical and biomarker data of 134 primary care patients with respiratory tract infections. ProADM was measured on admission and after 7 days in batch-analysis. 10-year follow-up data was collected by GP, patient and relative tracing through phone interviews. We calculated Cox regression models and area under the receiver operating characteristics curves to assess associations of ProADM with 10-year all-cause mortality. Results During the 10-year follow-up 6% of included patients died. Median baseline ProADM blood levels (nmol/l) were significantly higher in non-survivors compared to survivors (0.5, IQR 0.4–1.3; vs. 0.2, IQR 0.1–0.5; p = 0.02) and showed a significant association with 10-year all-cause mortality in an age-adjusted cox regression model (HR: 2.5, 95%-CI: 1.0–6.1, p = 0.04). ProADM levels on day 7 showed similar results. Conclusions This posthoc analysis found an association of elevated ProADM blood levels and 10-year all-cause mortality in a primary care cohort with respiratory tract infections. Due to the methodological limitations including incomplete data regarding follow-up information and biomarker measurement, this study warrants validation in future larger studies. Trial registration Current Controlled Trials, SRCTN73182671
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Affiliation(s)
- Jonas Odermatt
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Marc Meili
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Lara Hersberger
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Rebekka Bolliger
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Basel-Stadt, Switzerland.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Heiner C Bucher
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Basel-Stadt, Switzerland
| | - Beat Mueller
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Philipp Schuetz
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland.
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15
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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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16
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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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17
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Supeł K, Kacprzak M, Zielińska M. The prognostic value of MR-proadrenomedullin in patients with acute coronary syndrome complicated by cardiogenic shock. Biomarkers 2016; 22:296-303. [DOI: 10.1080/1354750x.2016.1252962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Karolina Supeł
- Department of Interventional Cardiology and Electrocardiology, Intensive Cardiac Therapy Clinic, Medical University of Lodz, Poland
| | - Michał Kacprzak
- Department of Interventional Cardiology and Electrocardiology, Intensive Cardiac Therapy Clinic, Medical University of Lodz, Poland
| | - Marzenna Zielińska
- Department of Interventional Cardiology and Electrocardiology, Intensive Cardiac Therapy Clinic, Medical University of Lodz, Poland
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18
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Sinning C, Zengin E, Zeller T, Schnabel RB, Blankenberg S, Westermann D. Candidate biomarkers in heart failure with reduced and preserved ejection fraction. Biomarkers 2016; 20:258-65. [PMID: 26301884 DOI: 10.3109/1354750x.2015.1068856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
CONTEXT Patients presenting with heart failure symptoms are categorized into heart failure (HF) with reduced and preserved ejection fraction. OBJECTIVE Aim is to investigate the additional use of candidate biomarkers to characterize patients with either sub-type of HF. METHODS Literature search was conducted in the electronic databases MEDLINE and Cochrane Central Register of Controlled Trials from inception through November 2014. RESULTS The results of 47 diseased and general population cohorts were included. CONCLUSION Current studies could outline the additional use of candidate biomarkers especially GDF-15, MR-proADM and high-sensitive determined troponin, although major outcome studies are still missing.
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Affiliation(s)
- Christoph Sinning
- a Department of General and Interventional Cardiology , University Heart Center Hamburg , Germany and
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19
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Landman GWD, Kleefstra N, Groenier KH, Bakker SJL, Groeneveld GH, Bilo HJG, van Hateren KJJ. Inflammation biomarkers and mortality prediction in patients with type 2 diabetes (ZODIAC-27). Atherosclerosis 2016; 250:46-51. [PMID: 27179179 DOI: 10.1016/j.atherosclerosis.2016.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 03/19/2016] [Accepted: 04/19/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND C-reactive protein (CRP), procalcitonin (PCT) and pro-adrenomedullin (MR-proADM) are inflammation markers associated with long-term mortality risk. We compared the associations and predictive capacities of CRP, PCT and MR-proADM with cardiovascular and all-cause mortality in patients with type 2 diabetes. METHODS This study included primary care treated patients with type 2 diabetes participating in the ZODIAC cohort study. A total of 1005 out of 1688 patients (60%) had complete baseline variables. Baseline CRP, PCT and MR-proADM were assessed in relation to cardiovascular and all-cause mortality with Cox proportional hazard analyses. Hazard Ratios (HR) were adjusted for age, gender, BMI, smoking, systolic blood pressure, cholesterol-HDL ratio, duration of diabetes, HbA1c, history of cardiovascular diseases, albumin-creatinine ratio and creatinine. Risk prediction capabilities were assessed with Harrell's C statistics and proportion of explained variance (R(2)). RESULTS After a median follow-up of 11 years, 472 (47%) of 1005 patients had died. The likelihood ratio test showed that CRP and MR-proADM significantly improved prediction in cardiovascular mortality [HRs 1.20 (95%CI 1.09-1.33) and 1.56 (95%CI 1.06-2.30)] and in all-cause mortality [HRs 1.10 (95%CI: 1.03-1.18) and 1.31 (95%CI 1.02-1.69)]. Harrell's C values and R(2) measures showed slightly improved discrimination for cardiovascular mortality in patients without macrovascular disease (C: 0.80 to 0.81; R(2): 0.50 to 0.52) and MR-proADM (C: 0.80 to 0.82; R(2): 0.50 to 0.52). CONCLUSIONS CRP and MR-proADM, but not PCT, were independently associated with cardiovascular and all-cause mortality. In patients without macrovascular diseases, CRP and MR-proADM slightly improved discrimination, in absolute sense, of patients at risk for cardiovascular mortality.
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Affiliation(s)
- Gijs W D Landman
- Langerhans Medical Research Institute, Zwolle, The Netherlands; Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands.
| | - Nanne Kleefstra
- Langerhans Medical Research Institute, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaas H Groenier
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Diabetes Research Centre, Isala Hospital, Zwolle, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geert H Groeneveld
- Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Diabetes Research Centre, Isala Hospital, Zwolle, The Netherlands
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20
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Suzuki Y, Katagiri F, Sato F, Fujioka T, Tanaka R, Sato Y, Mimata H, Itoh H. Association of metabolic complications with plasma mid-regional pro-adrenomedullin level in stable kidney transplant recipients. Clin Chim Acta 2016; 453:160-3. [PMID: 26706787 DOI: 10.1016/j.cca.2015.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recently, increased plasma mid-regional pro-adrenomedullin (MR-proADM) concentrations have been demonstrated in patients with chronic renal failure. In this study, we attempted to identify significant clinical factors associated with MR-proADM concentration in stable kidney transplant recipients. METHODS Forty-seven Japanese kidney transplant recipients who underwent transplantation >180days prior to the study were analyzed. To facilitate comparability of anti-hypertensive regimens across recipients taking different drugs, we calculated the treatment intensity score of anti-hypertensive drugs in each recipient. Morning blood samples were collected and plasma MR-proADM concentrations were measured using an enzyme immunoassay. RESULTS Multiple regression analysis identified treatment intensity score for anti-hypertensive drugs, serum albumin, creatinine clearance and use of lipid-lowering agents as significant independent factors associated with plasma MR-proADM concentration. Adjusted coefficient of determination for this model was 0.46. CONCLUSION Apart from indicating lowered renal function, plasma MR-proADM concentration may be a useful biomarker for metabolic disorders, especially hypertension and hyperlipidemia, in stable kidney transplant patients.
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Affiliation(s)
- Yosuke Suzuki
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita 879-5593, Japan.
| | - Fumihiko Katagiri
- Laboratory of Clinical Biochemistry, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo 192-0392, Japan
| | - Fuminori Sato
- Department of Urology, Faculty of Medicine, Oita University, Hasama-machi, Oita 879-5593, Japan
| | - Takashi Fujioka
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita 879-5593, Japan
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita 879-5593, Japan
| | - Yuhki Sato
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita 879-5593, Japan
| | - Hiromitsu Mimata
- Department of Urology, Faculty of Medicine, Oita University, Hasama-machi, Oita 879-5593, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita 879-5593, Japan
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21
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Schuetz P, Marlowe RJ, Mueller B. The prognostic blood biomarker proadrenomedullin for outcome prediction in patients with chronic obstructive pulmonary disease (COPD): a qualitative clinical review. Clin Chem Lab Med 2015; 53:521-39. [PMID: 25252756 DOI: 10.1515/cclm-2014-0748] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 08/24/2014] [Indexed: 01/29/2023]
Abstract
Plasma proadrenomedullin (ProADM) is a blood biomarker that may aid in multidimensional risk assessment of patients with chronic obstructive pulmonary disease (COPD). Co-secreted 1:1 with adrenomedullin (ADM), ProADM is a less biologically active, more chemically stable surrogate for this pluripotent regulatory peptide, which due to biological and ex vivo physical characteristics is difficult to reliably directly quantify. Upregulated by hypoxia, inflammatory cytokines, bacterial products, and shear stress and expressed widely in pulmonary cells and ubiquitously throughout the body, ADM exerts or mediates vasodilatory, natriuretic, diuretic, antioxidative, anti-inflammatory, antimicrobial, and metabolic effects. Observational data from four separate studies totaling 1366 patients suggest that as a single factor, ProADM is a significant independent, and accurate, long-term all-cause mortality predictor in COPD. This body of work also suggests that combined with different groups of demographic/clinical variables, ProADM provides significant incremental long-term mortality prediction power relative to the groups of variables alone. Additionally, the literature contains indications that ProADM may be a global cardiopulmonary stress marker, potentially supplying prognostic information when cardiopulmonary exercise testing results such as 6-min walk distance are unavailable due to time or other resource constraints or to a patient's advanced disease. Prospective, randomized, controlled interventional studies are needed to demonstrate whether ProADM use in risk-based guidance of site-of-care, monitoring, and treatment decisions improves clinical, quality-of-life, or pharmacoeconomic outcomes in patients with COPD.
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22
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Velho G, Ragot S, Mohammedi K, Gand E, Fraty M, Fumeron F, Saulnier PJ, Bellili-Munoz N, Bouby N, Potier L, Alhenc-Gelas F, Marre M, Hadjadj S, Roussel R. Plasma Adrenomedullin and Allelic Variation in the ADM Gene and Kidney Disease in People With Type 2 Diabetes. Diabetes 2015; 64:3262-72. [PMID: 25948679 DOI: 10.2337/db14-1852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/30/2015] [Indexed: 11/13/2022]
Abstract
Production of adrenomedullin (ADM), a vasodilator peptide, increases in response to ischemia and hypoxia in the vascular wall and the kidney. This may be an adaptive response providing protection against organ damage. We investigated the hypothesis that ADM has a nephroprotective effect in two prospective cohorts of patients with type 2 diabetes recruited in France. The highest tertile of plasma MR-proADM (a surrogate for ADM) concentration at baseline was associated with the risk of renal outcomes (doubling of plasma creatinine concentration and/or progression to end-stage renal disease) during follow-up in both cohorts. Four SNPs in the ADM gene region were associated with plasma MR-proADM concentration at baseline and with eGFR during follow-up in both cohorts. The alleles associated with lower eGFR were also associated with lower plasma MR-proADM level. In conclusion, plasma MR-proADM concentration was associated with renal outcome in patients with type 2 diabetes. Our data suggest that the ADM gene modulates the genetic susceptibility to nephropathy progression. Results are consistent with the hypothesis of a reactive rise of ADM in diabetic nephropathy, blunted in risk alleles carriers, and with a nephroprotective effect of ADM. A possible therapeutic effect of ADM receptor agonists in diabetic renal disease would be worth investigating.
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Affiliation(s)
- Gilberto Velho
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Stéphanie Ragot
- INSERM, Centre d'Investigation Clinique (CIC) 1402, Poitiers, France UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
| | - Kamel Mohammedi
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France Assistance Publique - Hôpitaux de Paris, Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, DHU FIRE, Paris, France
| | - Elise Gand
- Department of Endocrinology and Diabetology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Mathilde Fraty
- INSERM, Centre d'Investigation Clinique (CIC) 1402, Poitiers, France
| | - Frédéric Fumeron
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Pierre-Jean Saulnier
- INSERM, Centre d'Investigation Clinique (CIC) 1402, Poitiers, France UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France INSERM, Research Unit 1082, Poitiers, France
| | | | - Nadine Bouby
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France Université Paris Descartes, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Louis Potier
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France Assistance Publique - Hôpitaux de Paris, Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, DHU FIRE, Paris, France UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - François Alhenc-Gelas
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France Université Paris Descartes, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Michel Marre
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France Assistance Publique - Hôpitaux de Paris, Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, DHU FIRE, Paris, France UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Samy Hadjadj
- INSERM, Centre d'Investigation Clinique (CIC) 1402, Poitiers, France UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France Department of Endocrinology and Diabetology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France INSERM, Research Unit 1082, Poitiers, France
| | - Ronan Roussel
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France Assistance Publique - Hôpitaux de Paris, Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, DHU FIRE, Paris, France UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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23
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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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24
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Xue Y, Iqbal N, Chan J, Maisel A. Biomarkers in Hypertension and Their Relationship with Myocardial Target-Organ Damage. Curr Hypertens Rep 2014; 16:502. [DOI: 10.1007/s11906-014-0502-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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25
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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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Funke-Kaiser A, Havulinna AS, Zeller T, Appelbaum S, Jousilahti P, Vartiainen E, Blankenberg S, Sydow K, Salomaa V. Predictive value of midregional pro-adrenomedullin compared to natriuretic peptides for incident cardiovascular disease and heart failure in the population-based FINRISK 1997 cohort. Ann Med 2014; 46:155-62. [PMID: 24506434 DOI: 10.3109/07853890.2013.874662] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION To examine whether midregional pro-adrenomedullin (MR-proADM) plasma concentrations predict incident cardiovascular outcomes in the general population. Natriuretic peptides (N-terminal pro-brain natriuretic peptide (NT-proBNP), B-type natriuretic peptide (BNP), and midregional pro-atrial natriuretic peptide (MR-proANP)) were analyzed for comparison. MATERIAL AND METHODS MR-proADM plasma concentrations and those of the natriuretic peptides were determined in 8444 individuals of the FINRISK 1997 cohort. Patients were followed for 14 years (median). Cox regression analyses, discrimination, and reclassification analyses adjusting for Framingham risk factors were performed to evaluate the additional benefit from MR-proADM. RESULTS MR-proADM concentrations significantly predicted all-cause death (hazard ratio highest quintile versus lowest 1.18, 95% confidence interval 1.08-1.28), stroke (1.20, 1.05-1.38), major adverse cardiac events (MACE) (1.27, 1.17-1.37), and heart failure (1.67, 1.49-1.87). MR-proADM remained associated with MACE, death, and heart failure even after additional adjustment for NT-proBNP and C-reactive protein. Adding MR-proADM to the Framingham risk factors significantly improved discrimination (P < 0.001 for C-statistics and integrated discrimination improvement) and risk reclassification for heart failure (net reclassification improvement 12.12%, P < 0.001). CONCLUSIONS In a healthy general population sample of the FINRISK 1997 cohort MR-proADM significantly predicted all-cause death, MACE, and especially heart failure even beyond NT- proBNP. It also improved risk reclassification for heart failure.
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Lippi G, Schena F, Salvagno GL, Sanchis-Gomar F, Guidi GC. Serum copeptin and midregion proadrenomedullin (MR-proADM) after an ultramarathon. J Clin Lab Anal 2014; 29:15-20. [PMID: 24659530 DOI: 10.1002/jcla.21720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 10/31/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Although it is widely acknowledged that physical activity confers several health benefits, it remains uncertain whether strenuous and physically demanding exercise might determine biological effects that might turn to be ultimately unfavorable for health. Copeptin and midregion proadrenomedullin (MR-proADM) are emerging cardiovascular and stress biomarkers, but little is known about the influence of strenuous physical exercise on their concentrations. METHODS The present study was performed to investigate the variation of copeptin and MRproADM, along with that of serum creatinine and estimated glomerular filtration rate before and after a 60 km ultramarathon in 16 healthy Caucasian males. RESULTS The serum concentrations of both copeptin and MR-proADM remarkably increased after the 60 km run, by 6.4 times (interquartile range (IQR), 2.710.4) and 2.3 times (IQR, 1.8-2.6), respectively. A highly significant correlation was observed between the increase of creatinine and MR-proADM, but not between serum creatinine and copeptin. The percentage of subjects exhibiting values above the upper limit of the reference range in male was 0% for both copeptin and MR-proADM before the ultramarathon, but increased to respectively 81 and 63% postexercise. CONCLUSION The evidence that an ultramarathon causes a substantial increase of copeptin and MR-proADM raises doubts as to whether exhaustive exercise might be considered globally beneficial or even safe, especially in unfit or/and untrained population.
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Affiliation(s)
- Giuseppe Lippi
- U.O. di Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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28
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Sinning C, Kieback A, Wild PS, Schnabel RB, Ojeda F, Appelbaum S, Zeller T, Lubos E, Schwedhelm E, Lackner KJ, Debus ES, Munzel T, Blankenberg S, Espinola-Klein C. Association of multiple biomarkers and classical risk factors with early carotid atherosclerosis: results from the Gutenberg Health Study. Clin Res Cardiol 2014; 103:477-85. [PMID: 24488175 DOI: 10.1007/s00392-014-0674-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND In the Gutenberg Health Study, a random sample of the population was scanned with vascular ultrasound for early atherosclerosis. A continuous classical risk marker model (waist circumference, HbA1c, LDL/HDL ratio, pack years and pulse pressure) was compared to a model of modern biomarkers (C-reactive protein, troponin I, N-terminal pro B-type natriuretic peptide, copeptin, mid-regional pro-adrenomedullin, and asymmetric dimethylarginine) with regard to the ability of ruling out abnormal intima-media thickness (IMT), respectively, carotid plaques. METHODS Data of the first consecutive 5,000 participants (aged 35-74 years; 2,540 men, 2,460 women) were analyzed. IMT was measured at both common carotid arteries using an edge detection system. Plaques were defined as protrusion of ≥1.5 mm in common, internal and external carotid artery. RESULTS For classical risk factors, in comparison to a model of six modern biomarkers, regarding the variable (a) IMT>0.85 mm negative and positive predictive value (NPV and PPV) were 0.98 and 0.16 for both the classical risk factor model and the biomarker model. The second variable (b) presence of plaque could be ruled out with an NPV of 0.84 and identified with a PPV of 0.61 for classical risk factors, and 0.84 and 0.58 for biomarkers, respectively. Values were calculated using logistic regression analysis. CONCLUSION Classical risk factors allow ruling out pathologic IMT and presence of carotid plaques in a population of primary prevention in a reliable way. Modern biomarkers performed almost equally well but did not provide further information.
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Affiliation(s)
- Christoph Sinning
- University Hospital Hamburg-Eppendorf, University Heart Center Hamburg, Hamburg, Germany,
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Funke-Kaiser A, Mann K, Colquhoun D, Zeller T, Hunt D, Simes J, Sullivan D, Sydow K, West M, White H, Blankenberg S, Tonkin AM. Midregional proadrenomedullin and its change predicts recurrent major coronary events and heart failure in stable coronary heart disease patients: the LIPID study. Int J Cardiol 2014; 172:411-8. [PMID: 24508492 DOI: 10.1016/j.ijcard.2014.01.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/15/2014] [Accepted: 01/18/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Biomarkers may contribute to risk stratification in coronary heart disease (CHD). We examined whether plasma midregional proadrenomedullin (MR-proADM) concentration at baseline and its change over one year predicts long-term outcomes in stable CHD patients. METHODS The LIPID study randomised patients 3-36 months after an acute coronary syndrome with total cholesterol 4.0-7.0 mmol/L (155-271 mg/dL), to placebo or pravastatin 40 mg. Follow-up was 6.0 years. MR-proADM plasma concentrations at baseline and one year later were determined in 7863 and 6658 patients, respectively. These were categorised into quartiles to perform Cox regression analysis, adjusting for baseline parameters. RESULTS Baseline MR-proADM concentrations predicted major CHD events (non-fatal myocardial infarction or CHD death; hazard ratio (HR) 1.52, 1.26-1.84 for Q4-Q1), CHD death (HR 2.21, 1.67-2.92), heart failure (HR 2.30, 1.78-2.97) and all-cause mortality (HR 1.82, 1.49-2.23). Associations were still significant after adjustment for baseline B-type natriuretic peptide (BNP) concentration. Increase in MR-proADM after one year was associated with increased risk of subsequent CHD events (HR 1.34, 1.08-1.66), non-fatal myocardial infarction (HR 1.50, 1.12-2.03), heart failure (HR 1.78, 1.37-2.30) and all-cause mortality (HR 1.31, 1.04-1.64). Associations with heart failure and all-cause mortality remained significant after adjusting for baseline and change in BNP concentration. Change in MR-proADM moderately improved risk reclassification for major CHD events (net reclassification improvement (NRI) 3.48%) but strongly improved risk reclassification for heart failure (NRI 5.60%). CONCLUSIONS Baseline and change in MR-proADM concentrations over one year are associated with risk of major clinical events, even after adjustment for BNP concentrations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Harvey White
- Green Lane Cardiovascular Service, Auckland, New Zealand
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Midregional pro-adrenomedullin and copeptin: exercise kinetics and association with the cardiopulmonary exercise response in comparison to B-type natriuretic peptide. Eur J Appl Physiol 2014; 114:815-24. [DOI: 10.1007/s00421-013-2815-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
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Landman GWD, van Dijk PR, Drion I, van Hateren KJJ, Struck J, Groenier KH, Gans ROB, Bilo HJG, Bakker SJL, Kleefstra N. Midregional fragment of proadrenomedullin, new-onset albuminuria, and cardiovascular and all-cause mortality in patients with type 2 diabetes (ZODIAC-30). Diabetes Care 2014; 37:839-45. [PMID: 24170764 DOI: 10.2337/dc13-1852] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The midregional fragment of proadrenomedullin (MR-proADM) is a marker of endothelial dysfunction and has been associated with a variety of diseases. Our aim was to investigate whether MR-proADM is associated with new-onset albuminuria and cardiovascular (CV) and all-cause mortality in patients with type 2 diabetes treated in primary care. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes participating in the observational Zwolle Outpatient Diabetes Project Integrating Available Care (ZODIAC) study were included. Cox regression analyses were used to assess the relation of baseline MR-proADM with new-onset albuminuria and CV and all-cause mortality. Risk prediction capabilities of MR-proADM for new-onset albuminuria and CV and all-cause mortality were assessed with Harrell's C and the integrated discrimination improvement. RESULTS In 1,243 patients (mean age 67 [±12] years), the median follow-up was 5.6 years (interquartile range 3.1-10.1); 388 (31%) patients died, with 168 (12%) CV deaths. Log2 MR-proADM was associated with CV (hazard ratio 1.96 [95% CI 1.27-3.01]) and all-cause mortality (1.78 [1.34-2.36]) after adjusting for age, sex, BMI, smoking, systolic blood pressure, cholesterol-to-HDL ratio, duration of diabetes, HbA1c, ACE inhibitor/angiotensin receptor blocker, history of CV diseases, log serum creatinine, and log albumin-to-creatinine ratio. MR-proADM slightly improved mortality risk prediction. The age- and sex-adjusted, but not multivariate-adjusted, MR-proADM levels were associated with new-onset albuminuria. CONCLUSIONS MR-proADM was associated with CV and all-cause mortality in patients with type 2 diabetes after a median follow-up of 5.6 years. There was no independent relationship with new-onset albuminuria. In the availability of an extensive set of risk factors, there was little added effect of MR-proADM in risk prediction of CV and all-cause mortality.
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Sanchis-Gomar F, Bonaguri C, Aloe R, Pareja-Galeano H, Martinez-Bello V, Gomez-Cabrera MC, Candel J, Viña J, Lippi G. Effects of acute exercise and xanthine oxidase inhibition on novel cardiovascular biomarkers. Transl Res 2013; 162:102-9. [PMID: 23507375 DOI: 10.1016/j.trsl.2013.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/31/2013] [Accepted: 02/21/2013] [Indexed: 01/12/2023]
Abstract
Several sports have been associated with a postexercise increase of cardiac, liver, and skeletal muscle biomarkers of injury. Exhaustive or acute physical exercise causes an increased generation of reactive oxygen species, resulting in cellular injury. Thus, exercise and training may trigger pathophysiological changes in serum concentrations of a variety of biomarkers. In this study, we aimed to evaluate the variation of novel biomarkers of stress and cardiovascular disease such as copeptin, midregional part of proadrenomedullin (MR-proADM), growth differentiation factor 15 (GDF15), soluble vascular endothelial growth factor receptor, and placental growth factor along with uric acid before and after acute high-intensity exercise and allopurinol administration. We also assessed whether allopurinol administration may affect the circulating levels of these biomarkers by inhibition of XO activity. This is a double-blind, placebo-controlled study in which 12 professional football players were divided into 2 experimental groups. An oral dose of 300 mg of allopurinol was administered to one group of six participants 4 hours before a match of the Spanish Football League, whereas the other 6 participants received placebo (cellulose). Venous blood samples were obtained before the match (baseline) and twelve hours afterwards (post-match). Serum MR-proADM levels increased significantly in the placebo group, whereas serum GDF15 levels increased significantly in both the placebo and allopurinol group after the match. No differences in the other parameters tested were found after the match in any experimental group. The trend toward postexercise increase of serum MR-proADM and GDF15 levels shows that the metabolism of these proteins is clearly imbalanced after exercise, which thereby represents a potential source of biological variability in their clinical assessment.
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Qin YW, Teng X, He JQ, Du J, Tang CS, Qi YF. Increased plasma levels of intermedin and brain natriuretic peptide associated with severity of coronary stenosis in acute coronary syndrome. Peptides 2013; 42:84-8. [PMID: 23391507 DOI: 10.1016/j.peptides.2013.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 01/21/2013] [Accepted: 01/21/2013] [Indexed: 02/07/2023]
Abstract
Intermedin (IMD) is a newly discovered peptide with increased levels in plasma and cardiac tissue in mice with ischemia/reperfusion. Continuous administration of low dose IMD markedly elevated the mRNA abundance of myocardial BNP in rats. Plasma BNP levels may reflect the severity of degree of coronary stenosis in patients with acute coronary syndrome (ACS). However, the role of circulating IMD in coronary heart disease remains unclear. We aimed to examine the plasma content of IMD and brain natriuretic peptide (BNP) and its clinical significance in patients with ACS. We collected plasma samples from 41 patients with ACS and 31 controls and measured IMD and BNP levels by radioimmunoassay. The severity of coronary artery stenosis for patients with ACS was measured by coronary angiography. Plasma IMD and BNP levels were markedly higher in ACS patients than that in controls (P<0.05). The increased plasma IMD and BNP were positively correlated with degree of coronary stenosis in ACS patients (r=0.263 and r=0.238, respectively, both P<0.05). In addition, plasma levels of IMD were positively correlated with BNP levels.
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Affiliation(s)
- Yan-Wen Qin
- The Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing An Zhen Hospital, Capital Medical University, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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Neumann JT, Tzikas S, Funke-Kaiser A, Wilde S, Appelbaum S, Keller T, Ojeda-Echevarria F, Zeller T, Zwiener I, Sinning CR, Jagodzinski A, Schnabel RB, Lackner KJ, Münzel T, Blankenberg S, Wild PS, Sydow K. Association of MR-proadrenomedullin with cardiovascular risk factors and subclinical cardiovascular disease. Atherosclerosis 2013; 228:451-9. [PMID: 23562132 DOI: 10.1016/j.atherosclerosis.2013.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/20/2013] [Accepted: 03/03/2013] [Indexed: 02/06/2023]
Abstract
AIMS AND BACKGROUND Midregional proadrenomedullin (MR-proADM) is a protein, which exerts various effects on the cardiovascular system. Recent studies underscored its prognostic implications in patients with acute dyspnea and cardiovascular diseases. Therefore, we aimed to determine the distribution of MR-proADM in the general population and to reveal potential associations of MR-proADM with cardiovascular risk factors and measures of subclinical cardiovascular disease. METHODS AND RESULTS MR-proADM plasma concentrations were determined in individuals of the population-based cohort of the Gutenberg Health Study (N = 5000) using a commercially available fluoroimmunoassay. Individuals were enrolled between April 2007 and October 2008. Subclinical cardiovascular disease was assessed using echocardiographic and functional measures of myocardial and vascular function. The mean age of the study population was 55.5 ± 10.9 years. In the overall population we determined a median MR-proADM plasma concentration of 0.44 nmol/L in men and women. MR-proADM concentrations were elevated in individuals with hypertension, diabetes, dyslipidemia, known cardiovascular disease, heart failure, peripheral artery disease, atrial fibrillation, and history of myocardial infarction and stroke. In men, we observed a positive association of MR-proADM with reduced ejection fraction, intraventricular septal diameter, wall thickness, and echocardiographic measures of diastolic dysfunction. CONCLUSIONS In this study, we present age-dependent reference values for MR-proADM in a representative population sample. Elevated MR-proADM plasma concentrations were strongly associated with classical cardiovascular risk factors and manifest cardiovascular diseases. Furthermore, we revealed a gender-specific association with echocardiographic measures of hypertension. MR-proADM seems to be a promising prognostic biomarker for subclinical and manifest cardiovascular disease.
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Affiliation(s)
- Johannes Tobias Neumann
- Department of General and Interventional Cardiology, Hamburg University Heart Center, Martinistraße 52, 20246 Hamburg, Germany
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Rapid response team-triggered procalcitonin measurement predicts infectious intensive care unit transfers*. Crit Care Med 2012; 40:2090-5. [PMID: 22564964 DOI: 10.1097/ccm.0b013e31824fc027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Determine if procalcitonin at the time of initial rapid response team activation identifies patients who are likely to need subsequent intensive care unit transfer. DESIGN Prospective observational cohort study. SETTING Urban, tertiary care hospital with rapid response team activation through an electronic modified early warning score. PATIENTS One hundred nineteen oncology and 100 consecutive non-oncology patients after initial rapid response team visit precipitated by an elevated electronic modified early warning score were recruited. Rapid response team activations by request of nursing or for other reasons were not studied. Five oncology patients seen by a rapid response team for complications of interleukin-2 therapeutic infusions were subsequently excluded. INTERVENTIONS Residual serum from the next ordered clinical test (within 12 hrs) was retrieved, frozen, and stored for procalcitonin determination. A second sample 12-24 hrs after the initial specimen was also retrieved if available and if the patient had not yet been transferred to the intensive care unit. MEASUREMENTS AND MAIN RESULTS Seventy-three patients (33%) were transferred to the intensive care unit. Rapid response team activations that did not result in intensive care unit transfer had significantly lower procalcitonin levels (median 0.28 ng/mL [interquartile range 0.09-1.24]) than those that resulted in intensive care unit transfer (median 0.51 ng/mL [interquartile range 0.11-1.97], p = .0001) but the area under the receiver operating curve was only 0.656. The change in procalcitonin level in patients with intensive care unit transfers was very heterogeneous but was significantly increased compared to the change in patients not transferred to the intensive care unit. Procalcitonin levels for intensive care unit transfers for probable or definite infection were 2.28 ng/mL [interquartile range 0.68-8.05], and were significantly greater than rapid response team visits that did not result in transfer (p = .0001). The difference between infectious and noninfectious intensive care unit transfers (0.95 ng/mL [interquartile range 0.26-1.89]) was also significant (p = .03). The procalcitonin levels of patients with noninfectious intensive care unit transfers were also different than the levels of patients who never transferred (p = .04). CONCLUSIONS Preliminary results suggest procalcitonin levels in patients at the time of initial visit by a rapid response team correlate with the need for subsequent intensive care unit transfer, particularly for infectious reasons.
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Benditt DG, Chen LY. Peptides in Postural Orthostatic Tachycardia Syndrome. J Am Coll Cardiol 2012; 60:321-3. [DOI: 10.1016/j.jacc.2012.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/16/2012] [Indexed: 11/29/2022]
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Wierzbicki AS. New directions in cardiovascular risk assessment: the role of secondary risk stratification markers. Int J Clin Pract 2012; 66:622-30. [PMID: 22698414 DOI: 10.1111/j.1742-1241.2012.02956.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cardiovascular disease (CVD) risk screening is performed by multivariate methods relying on calculators derived from the Framingham study, other epidemiological studies or primary care records. However, it only identifies 70% of individuals at risk for CVD events and there has been interest in adding other risk factors to improve its predictive capacity. The addition of a family history of premature CVD is well established and there is evidence for adding lipoprotein (a) in some populations and possibly C-reactive protein may be suitable for general use in CVD risk assessment. Most new biochemical and imaging markers have been assessed in the context of improving risk classification in intermediate-risk groups rather than in the general population. There is evidence that N-terminal pro-B-type natriuretic peptide and coronary artery calcium score add significantly to risk prediction. The data for carotid intima-media thickness, ankle-brachial index are less strong and high sensitivity troponins look promising, but have had only limited data to date. Large scale meta-analyses ideally of pooled primary patient data will be required to determine the best additional markers to add to conventional risk prediction and in what groups to apply them.
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Affiliation(s)
- A S Wierzbicki
- Consultant in Metabolic Medicine/Chemical Pathology, St. Thomas' Hospital Campus, Lambeth Palace Road, London SE1 7EH, UK.
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Potocki M, Ziller R, Mueller C. Mid-Regional Pro-Adrenomedullin in Acute Heart Failure: A Better Biomarker or Just Another Biomarker? Curr Heart Fail Rep 2012; 9:244-51. [DOI: 10.1007/s11897-012-0096-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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