Abstract 12153: Elevated Plasma Asymmetric Dimethylarginine, an Endogenous Inhibitor of Nitric Oxide Synthesis, Predicts Impaired Cardiopulmonary Response and Unexpected Hospitalization in Adults with Congenital Heart Disease
Background: Asymmetric dimethylarginine (AMDA) is an endogenous inhibitor of nitric oxide (NO) synthesis, which adversely affects endothelial function and influences prognosis in cardiovascular patients. However, no data on ADMA are available in adults with congenital heart disease (ACHD). Objectives: To clarify whether ADMA are increased in ACHD and the different impact on patients after Fontan and biventricular repairs (BVR).
Methods and Results: ADMA (µ mol/L) was measured in consecutive 28 cyanotic, 104 Fontan, 174 BVR patients and 27 controls. ADMA was highest in the cyanotic patients (0.59 ± 0.12), followed by the Fontan patients (0.50 ± 0.09), BVR patients (0.48 ± 0.08) and controls (0.43±0.07) (p < 0.0001). In the Fontan patients, pulmonary artery pressure (PAP), hypoxia, hyperglycemia during glucose tolerance test, plasma norepinephrine and rennin activities (PRA) were associated with the ADMA and the PAP was independently associated with the ADMA (p < 0.05). In the BVR patients, cardiac index, arterial pressure, plasma brain natriuretic peptide, PRA and renal function were associated with the ADMA and the PRA and renal function were independently associated with the ADMA (p < 0.05). In the both ACHD groups, higher ADMA levels correlated positively with impaired ventilatory efficiency and inversely with peak oxygen uptake (p < 0.05 - 0.001) and the high ADMA predicted unexpected hospitalizations in the Fontan patients (p < 0.001).
Conclusions: ACHD patients exhibit the high ADMA levels and the close association with the exercise pathophysiology. Furthermore, a high ADMA has a prognostic value in the adult Fontan patients.
- © 2012 by American Heart Association, Inc.