Abstract 3478: Midregional Pro-Adrenomedullin (MR-proADM) in a Cardiovascular Risk Population- Impact on Diastolic Dysfunction
Background: Adrenomedullin (ADM), released by the endothelium and adipose tissue, is associated with increased arterial stiffness and directly affects circulation control due to atrial and ventricular myocardial function. Endothelial dysfunction and overweight are risk factors for diastolic dysfunction (DD) and diastolic heart failure. However, the impact of ADM on DD and the occurrence of symptoms in a cardiovascular risk population have been not investigated so far.
Methods: 1687 patients (age ≥50y) with ≥1 cardiovascular risk factor (e.g. hypertension, diabetes) or known heart failure were prospectively included into the DIAST-CHF-trial of the German Heart Failure Network (KNHI). Clinical examinations, echocardiography including diastolic function and MR-proADM plasma concentrations were recorded in all patients. Values are given as mean (±SD). Groups were compared by Mann-Whitney-U-Test. Correlations were tested using Pearson coefficient.
Results: n=1687 (age 66±8y, 50% female, BMI 29±8kg/m2, BPsys 146±22mmHg, BPdia 83±12mmHg, HR 71±12bpm). LVEF 60±8%, LAVI 25±10ml/m2, E/E′13±5, DD grade 0 n=279 (16,5%), DD grade I n=963 (57,1%) DD grade II/III n=248 (14,7%), LVEF<50% n=135 (8%). Overall MR-proADM was 0.61±0,2nmol/l (logADM −0.24±0.13). In DD log MR-proADM was higher than in patients without DD (p<0,0001), but lower than in systolic dysfunction (p<0,0001). Independent of diastolic or systolic dysfunction, we found significant higher plasma levels in patients who offer at least one heart failure symptom (Framingham criteria). Log MR-proADM was correlated to E/A (r=−0,80; p<001), LAVI (r=0,213; p<0,001), LVMI (r=0,102; p<0,001), E/E′(r=0,187; p<0,001), and to the value of symptoms such as edema (r=0,226;p<0,001), dyspnea et exertion (r=0,236; p<0,001), orthopnea (r=0,77; p<0,001), amount of Framingham criteria (r=0,256; p<0,001).
Conclusion: ADM is increased in patients with DD and correlates significantly with prognostic relevant parameters of diastolic function. Furthermore, ADM plasma levels are significantly higher in patients who offer heart failure symptoms. Therefore ADM may play a key role in the development of diastolic dysfunction and progression to diastolic heart failure.