Abstract 1689: Midregional Pro-Adrenomedullin vs. N-Terminal Pro-Brain Natriuretic Peptide for Diagnosis of Diastolic Disturbances: Results From the Community-Based Gutenberg-Heart Study
Background: Midregional pro-adrenomedullin (ADM) is considered as a newly identified prognostic marker in heart failure. Preliminary data showed ADM to be superior to N-terminal pro-BNP (BNP) in predicting early outcome in acute heart failure.
Objectives: To evaluate the associations between diastolic disturbances and ADM and BNP.
Methods: Biomarker concentrations were measured in 5.000 participants of the age- and gender-stratified, community-based Gutenberg-Heart Study, examined from 2007 to 2008. Cardiovascular risk factors, clinical parameters and echocardiograms were assessed by current standardized methods with detailed quality control.
Results: Medians of ADM concentrations in the 2540 men and 2460 women (age: 56 ± 11 years, range 35–74) were comparable (0.41 vs. 0.41nmol/l), whereas BNP concentrations were higher in women (31 vs. 71pg/ml). Compared to normal cardiac function, biomarker concentrations were significantly higher in prevalent diastolic dysfunction (DD; ADM: m/w 0.52nmol/l, BNP: m 66pg/ml, w 92 pg/ml), as well as in diastolic heart failure (DHF; ADM: m 0.60nmol/l, w 0.58nmol/l; BNP: m 132pg/ml, w 106pg/ml). Both biomarkers showed increasing concentrations with increasing severity of diastolic disturbance (normal, mild, moderate and severe). In C-statistics, the area under the curve (AUC) was significantly higher for ADM, than for BNP in both, DD and DHF (DD: ADM 0.67 vs. BNP 0.59, p < 0.001, DHF: ADM 0.77 vs. BNP 0.67, p < 0.001). When performing phenotype-specific cut-off analyses by maximizing the Youden Index, ADM showed better test characteristics than BNP (DD: Sensitivity (SE) 70% vs. 68%, specificity (SP) 57% vs. 47%, negative predictive value (NPV) 90% vs. 88%, DHF: SE 61% vs. 44%, SP 81% vs. 83%, NPV 98% vs. 97%). After adjustment for all cardiovascular risk factors, a value above the specific cut-off for ADM is independently associated with DD (OR 1.32, p = 0.008) and DHF (OR 2.20, p < 0.001), whereas for BNP it is associated with DHF (OR 1.97, p < 0.001), but not with DD (p = 0.89).
Conclusion: Increasing ADM and BNP concentrations are associated with the presence and severity of diastolic dysfunction and diastolic heart failure. Overall, ADM shows the better diagnostic performance compared to BNP for diastolic disturbances.