Plasma Adrenomedullin Relation with Doppler-Derived dP/dt in Patients with Congestive Heart Failure

Background: Increased circulating adrenomedullin (AM) concentration has been reported in congestive heart failure (HF) and considered as a possible marker of cardiac dysfunction. Hypothesis: The study was undertaken to assess the relationship between circulating AM concentration and left ventricular (LV) functional state, estimated by echo-Doppler techniques in patients with mild to moderate HF and different degrees of LV dysfunction. Methods: Plasma AM, B-type natriuretic peptide (BNP), and N-terminal (NT) proBNP levels were measured in 55 patients with HF (New York Heart Association [NYHA] I n = 8, II n = 26, III n = 21) and in 20 controls; dP/dt was calculated by the Doppler tracing of the mitral regurgitation jet. Results: The study was completed in 51 patients. Adre-nomedullin levels were higher than in controls (19.2 ± 1.4 vs. 13.3 ± 0.7, p<0.005) and elevated in proportion to NYHA functional class. B-type natriuretic peptide and NT-proBNP were 344 ± 67 vs. 12 ± 2 pg/ml and 2196 ± 623 vs. 52 ± 4 pg/ml, respectively (p<0.0001); dP/dt was better related to AM (r = 0.582, p<0.001) than to the other peptides. Adrenomedullin was significantly (p<0.001) different between patients grouped according to the dP/dt cut-off predictive of event-free survival. Conclusions: The combination of depressed contractility and increased AM may provide a clue for further characterization of the severity of LV dysfunction in HF, independent of baseline LV ejection fraction.