Association of midregional proadrenomedullin with coronary artery stenoses, soft atherosclerotic plaques and coronary artery calcium

Abstract

Midregional proadrenomedullin (MR-proADM) is elevated in patients with heart failure and myocardial infarction. The aim of this study was to evaluate the association of MR-proADM with the grade of coronary artery stenosis, presence of coronary artery soft plaques and coronary artery calcification score (CACS), determined by 64-multislice computed tomography (MSCT) in patients without known prior cardiovascular disease. This retrospective study included 107 patients undergoing MSCT for confirmation (or exclusion) of coronary artery disease. MR-proADM levels were measured in all patients. The assessment of coronary artery stenoses, CACS and soft coronary plaques was made by MSCT using known criteria. The MR-proADM [median (25th-75th percentiles)] level was 0.33 (0.21-0.43) nmol/l. The MR-proADM level was 0.28 (0.22-0.40) nmol/l in patients with coronary stenoses ≥50% (n = 23) versus 0.33 (0.27-0.40) nmol/l in patients with coronary stenoses <50% (n = 83, P = 0.59), 0.33 (0.26-0.40) nmol/l in patients with soft plaques (n = 56) versus 0.33 (0.25-0.41) nmol/l in patients without soft plaques (n = 50, P = 0.73) and 0.33 (0.25-0.39) nmol/l in patients with CACS <200 (n = 81) versus 0.32 (0.26-0.44) nmol/l in patients with CACS ≥200 (n = 26, P = 0.77). In multivariate analysis, the MR-proADM level was a significant correlate of coronary artery stenoses [odds ratio (OR) = 0.93; 95% confidence interval (CI) 0.86-0.99; P = 0.026] and soft plaques (OR = 0.94; 95% CI 0.90-0.99; P = 0.015) but not of CACS (OR = 0.98; 95% CI 0.93-1.03; P = 0.36). A decreased MR-proADM level is an independent correlate of the presence of coronary artery disease and of soft atherosclerotic plaques. Patients with decreased MR-proADM levels may need invasive examinations to diagnose more severe forms of coronary artery disease.

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“…The investigators demonstrated, using regression analysis, the predictive value of N-BNP and CRP for cardiovascular events, while N-BNP and MR-proADM have proven effective in assessing the risk of acute coronary events. In a similar study, Ross et al demonstrated that MR-proADM levels can predict the presence of a coronary artery stenosis (p = 0.026) or soft atherosclerotic plaques (p = 0.026) in patients without known CVD [226]. Yoshihara et al evaluated the role of MR-proADM as a biomarker of cardiac dysfunction in hemodialysis patients and concluded that increased plasma levels correlate positively with cardiac dysfunction, inflammatory status, and with volemia in patients with concomitant renal and cardiovascular disease [227].…”

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“…Similarly, there are no data on these biomarkers for long-term falls risk, although their relationship with syncope and structural vascular disease conceptually supports this link. Animal studies in rats consistently demonstrate adrenomedullin inhibits vascular calcification,9 however no association between plasma MR-proADM with coronary calcification was observed in humans 10. An experimental study in a chronic kidney disease animal model in rats suggests that endothelin-1 may also be involved in vascular calcification with blockade of the endothelin-1 receptor inhibiting vascular calcification,11 but there are no human data.…”