The evaluation of the clinical utility of urocortin 1 and adrenomedullin versus proBNP in systolic heart failure

Abstract

Objective:Urocortin 1 (UCN1) has vasodilator, diuretic, and natriuretic effects, and its expression increases in heart failure (HF). Adrenomedullin (ADM) increases cardiac output and lowers blood pressure in healthy men and in patients with heart failure. The aim of the study was to determine UCN1 and ADM levels in patients with HF, to evaluate the relationship of UCN1 and ADM with various clinical parameters, and to assess UCN1 and ADM as diagnostic markers in HF, in comparison with pro-brain natriuretic peptide (pro-BNP).Methods:We investigated serum levels of UCN1, ADM, and pro-BNP in 86 consecutive patients with systolic HF [ejection fraction (EF) ≤45%] and 85 healthy controls. Serum UCN1, ADM, and pro-BNP levels were measured with the ELISA method. Transthoracic echocardiography was performed to determine left ventricular EF and pulmonary artery systolic pressure.Results:UCN1 and ADM levels were higher in HF patients (446.2±145.7 pg/mL, p<0.001; 87.9±4.2 pg/mL, p<0.001 respectively). UCN1 was positively correlated with pro-BNP (r=0.963, p<0.001), ADM (r=0.915, p<0.001), and NYHA (r=0.879, p<0.001); ADM was positively correlated with pro-BNP (r=0.956, p<0.001) and NYHA (r=0.944, p<0.001). Receiver operating characteristic curves yielded an area under the curve of 1.00 (p<0.001) for UCN1, 1.00 (p<0.001) for ADM, and 0.99 (p<0.001) for pro-BNP in the diagnosis of HF.Conclusion:UCN1 and ADM increase with worsening HF and left ventricular dysfunction. They may be used as diagnostic biomarkers in systolic HF, but the incremental value of measuring UCN1 and ADM in patients tested for pro-BNP is questionable.

Assessment of clinical data on urocortins and their therapeutic potential in cardiovascular diseases: A systematic review and meta‐analysis

“…With regard to the blood levels of Ucns in cardiovascular diseases, we found numerous clinical studies that confirmed increased blood levels of Ucn1 and Ucn2 in a wide variety of cardiovascular diseases from hypertension to chronic HF, or from atrial fibrillation to aortic aneurysm 21 , 27 , 28 , 32 , 34 , 36 , 37 , 38 , 39 , 41 , 43 , 44 (Tables 1 and 2 ).…”

“…With regard to Ucn1, 12 studies measured the plasma levels in healthy volunteers 26 and in patient groups with various cardiovascular diseases, such as acute myocardial infarction (AMI; with or without controls) 27 or HF. 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 Seven studies reported significantly increased blood Ucn1 levels in cardiovascular diseases as compared with healthy controls (Table 1 ). 27 , 28 , 32 , 34 , 36 , 37 , 38 …”

“…28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 Seven studies reported significantly increased blood Ucn1 levels in cardiovascular diseases as compared with healthy controls (Table 1 ). 27 , 28 , 32 , 34 , 36 , 37 , 38 …”

“…Concerning Ucn1, most studies confirmed higher hormone levels in HF or AMI 27 , 28 , 32 , 34 , 36 , 37 , 38 as compared with controls. However, Ucn1 levels did not always correlate with the severity of the disease.…”

“…33 , 34 Our meta‐regression also failed to confirm any correlation between serum Ucn1 and LVEF (Figure S1 ), although several individual studies demonstrated correlations between Ucn1 levels and the New York Heart Association (NYHA) stage of the HF. 36 , 37 , 38 …”