Bioactive adrenomedullin for assessment of venous congestion in heart failure

Egerstedt, Anna; Czuba, Tomasz; Bronton, Kevin; Lejonberg, Carl; Ruge, Thoralph; Wessman, Torgny; Rådegran, Göran; Schulte, Janin; Hartmann, Oliver; Melander, Olle; Smith, Josh

doi:10.1002/ehf2.14018

Cited by 13 publications

(10 citation statements)

References 32 publications

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“…29,30 A recent study found that bioactive plasma ADM were associated with MRAP and PAWP measured by RHC, thus proposing it as a biomarker of systemic venous congestion in patients with HF. 32 This is in line with our results demonstrating that ADM levels in patients with advanced HF correlated with MRAP and NT-proBNP. Elevated ADM levels have been demonstrated to successfully predict disease severity and prognosis in chronic HF.…”

Section: Discussionsupporting

confidence: 91%

“…Furthermore, some studies suggest that ADM could reduce hypertrophy, remodelling, and fibrosis of the myocardium 29,30 . A recent study found that bioactive plasma ADM were associated with MRAP and PAWP measured by RHC, thus proposing it as a biomarker of systemic venous congestion in patients with HF 32 . This is in line with our results demonstrating that ADM levels in patients with advanced HF correlated with MRAP and NT‐proBNP.…”

Section: Discussionsupporting

confidence: 91%

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Adrenomedullin peptides and precursor levels in relation to haemodynamics and prognosis after heart transplantation

et al. 2023

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Aims Heart failure (HF) is a frequent condition in the elderly, further complicated by associated pulmonary hypertension (PH), with impact on morbidity and mortality. Plasma proteins associated with cardiovascular disease, related to inflammation, neurohormonal changes, and myocyte stress, pathways recognized in the pathophysiology of HF, may provide information on disease severity and prognosis. We aimed to investigate such cardiovascular proteins and their relationship to haemodynamics before and 1 year after heart transplantation (HT), as well as their prognostic value in advanced HF with PH. Methods and results In 20 healthy controls and 67 patients with HF and PH, before and 1 year after HT, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) and 18 cardiovascular proteins were analysed with proximity extension assay. Right heart catheterization was used to measure the haemodynamics of the HF patients pre‐operatively and at 1 year follow‐up after HT. Prognosis was estimated using Kaplan–Meier and Cox regression analyses. Out of 18 plasma proteins, 11 proteins including adrenomedullin peptides and precursor levels (ADM) and protein suppression of tumourigenicity 2 receptor were elevated before HT compared with healthy controls and had decreased 1 year after HT. The decrease in plasma levels 1 year after HT was towards the healthy controls' levels. The decrease in ADM levels before vs. after HT correlated with decreased mean right atrial pressure (rs = 0.61; P = 0.0077), decreased NT‐proBNP (rs = 0.75; P = 0.00025), and decreased stroke volume index (rs = −0.52; P = 0.022). High levels of pre‐operative plasma ADM were associated with worse event‐free survival (HT or death), as well as survival compared with low ADM levels (log‐rank P value = 0.023 and 0.0225, respectively). Univariable Cox regression analysis demonstrated that ADM levels were associated with survival, hazard ratio (HR) 1.007 (95% confidence interval (CI): 1.00–1.015, P = 0.049), and the association remained after adjusting for NT‐proBNP, HR 1.01 (95% CI: 1.00–1.021, P = 0.041). Conclusions Elevated plasma levels of ADM may be a marker of pressure/volume overload in HF patients with PH, as well as long‐term prognosis after HT. In line with previous studies, our findings additionally confirm that ADM may be a marker of venous congestion in HF. Further studies are encouraged to establish a deeper understanding of the properties of ADM and its relationship with HF and PH, in order to potentially facilitate clinical management of HF and associated PH.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Adrenomedullin peptides and precursor levels in relation to haemodynamics and prognosis after heart transplantation

et al. 2023

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“…Biomarkers that support accurate congestion assessment are desperately needed because congestion is infamously hard to measure accurately with high observer variability [ 95 ]. Recent studies highlight the strong association of increasing bio-ADM with systemic congestion and adverse outcomes independent of NT-proBNP [ 96 ].…”

Section: Reviewmentioning

confidence: 99%

Novel Biomarkers in Early Detection of Heart Failure: A Narrative Review

Kayani,

Fatima,

Yarra

et al. 2024

Cureus

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Heart failure (HF) represents a significant global health challenge, characterized by a variety of symptoms resulting from cardiac dysfunction. This dysfunction often leads to systemic and pulmonary congestion. The pathophysiology of HF is complex, involving stimulation of the sympathetic nervous system, which is insufficiently balanced by the release of natriuretic peptide. This imbalance leads to progressive hypertrophy and dilatation of the heart’s chambers, impairing its pumping efficiency and increasing the risk of arrhythmias and conduction disorders. The prevalence of HF is exceptionally high in industrialized nations and is expected to increase owing to an aging population and advancements in diagnostic methods. This study emphasizes the critical role of early diagnosis in reducing morbidity and mortality associated with HF, focusing specifically on the evolving importance of biomarkers in managing this condition. Biomarkers have played a key role in transforming the diagnosis and treatment of HF. Traditional biomarkers such as b-type natriuretic peptide and N-terminal pro-b-type natriuretic peptide have been widely adopted for their cost-effectiveness and ease of access. However, the rise of novel biomarkers such as growth differentiation factor 15 and adrenomedullin has shown promising results, offering superior sensitivity and specificity. These new biomarkers enhance diagnostic accuracy, risk stratification, and prognostic evaluation in HF patients. Despite these advancements, challenges remain, such as limited availability, high costs, and the need for further validation in diverse patient populations. Through a comprehensive literature review across databases such as PubMed, Google Scholar, and the Cochrane Library, this study compiles and analyzes data from 18 relevant studies, offering a detailed understanding of the current state of HF biomarkers. The study examines both traditional and emerging biomarkers such as galectin-3 and soluble suppression of tumorigenicity 2 in HF, exploring their clinical roles and impact on patient outcomes.

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“…BioADM has been studied as a marker in the evaluation of venous congestion associated with heart failure and correlates very well with measures of systemic congestion and mortality in decompensated heart failure. ADM is released by endothelial and vascular smooth muscle cells in response to intravascular volume overload and plays a key role in maintaining endothelial barrier function, thereby regulating tissue volume and edema [ 74 ]. In fact, the role of biomarkers to evaluate pulmonary and systemic congestion and distinguish phenotypes has recently been highlighted [ 75 ].…”

Section: The Best Biomarkers In Intensive and Perioperative Carementioning

confidence: 99%

Biomarkers as Prognostic Predictors and Therapeutic Guide in Critically Ill Patients: Clinical Evidence

Hernández

Rueda

2023

JPM

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A biomarker is a molecule that can be measured in a biological sample in an objective, systematic, and precise way, whose levels indicate whether a process is normal or pathological. Knowing the most important biomarkers and their characteristics is the key to precision medicine in intensive and perioperative care. Biomarkers can be used to diagnose, in assessment of disease severity, to stratify risk, to predict and guide clinical decisions, and to guide treatments and response to them. In this review, we will analyze what characteristics a biomarker should have and how to ensure its usefulness, and we will review the biomarkers that in our opinion can make their knowledge more useful to the reader in their clinical practice, with a future perspective. These biomarkers, in our opinion, are lactate, C-Reactive Protein, Troponins T and I, Brain Natriuretic Peptides, Procalcitonin, MR-ProAdrenomedullin and BioAdrenomedullin, Neutrophil/lymphocyte ratio and lymphopenia, Proenkephalin, NefroCheck, Neutrophil gelatinase-associated lipocalin (NGAL), Interleukin 6, Urokinase-type soluble plasminogen activator receptor (suPAR), Presepsin, Pancreatic Stone Protein (PSP), and Dipeptidyl peptidase 3 (DPP3). Finally, we propose an approach to the perioperative evaluation of high-risk patients and critically ill patients in the Intensive Care Unit (ICU) based on biomarkers.

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Bioactive adrenomedullin for assessment of venous congestion in heart failure

Cited by 13 publications

References 32 publications

Adrenomedullin peptides and precursor levels in relation to haemodynamics and prognosis after heart transplantation

Adrenomedullin peptides and precursor levels in relation to haemodynamics and prognosis after heart transplantation

Novel Biomarkers in Early Detection of Heart Failure: A Narrative Review

Biomarkers as Prognostic Predictors and Therapeutic Guide in Critically Ill Patients: Clinical Evidence

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