Abstract 2504: Plasma Asymmetric Dimethylarginine (ADMA) Levels And Short Outcome In Elderly Patients With Severely Exacerbated Heart Failure
Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, is elevated in congestive heart failure, associated with the severity of heart failure. We investigated the association between plasma ADMA level and early prognosis in elderly patients with severely exacerbated heart failure. Plasma ADMA, symmetric dimethylarginine (SDMA), arginine (Arg), plasma BNP and serum interleukin 6 (IL-6) concentrations were measured at admission in 52 elderly patients (82Â ± 2 years, 38 women) with exacerbated heart failure (pulmonary congestion and hypoxemia). ADMA was measured with HPLC (0.47Â ± 0.09 Â μmol/L in normal control). Patients with infection and renal failure (serum creatinine > 2.0 mg/dl) were excluded from the study. Eight patients (Group A) died without improvement of heart failure. Other 44 patients (Group B) were able to discharge. Although SDMA was not different between the 2 groups, ADMA was significantly higher in the Group A than in the Group B (0.62Â ± 0.19 vs. 0.53Â ± 0.15 Â μmol/L, respectively, p < 0.05). Furthermore, Arg was significantly lower in Group A than in Group B, resulting in higher ADMA/Arg ratio in the Group A (1.61Â ± 0.88 vs. 1.04Â ± 0.64 x10–2, respectively, p < 0.001) (0.61Â ± 0.11 in normal control). The ADMA/Arg ratio in the group B was not affected by heart failure treatment. The ADMA/Arg ratio was positively correlated with BNP and IL-6 levels (p < 0.05 for both), and both BNP and ADMA/Arg ratio were independent predictors of cardiac death (p < 0.001 in logistic regression analysis). In conclusion, these findings suggest that ADMA metabolism closely correlates with pathophysiology of heart failure in elderly patients, and supports the need for future studies examining the administration of L-arginine for treatment of elderly heart failure patients.