Abstract 10226: Bioactive Adrenomedullin for Assessment of Venous Congestion in Heart Failure

Abstract

Introduction: Bioactive adrenomedullin (bio-ADM) is a vascular-derived peptide hormone that has emerged as a promising biomarker for assessment of congestion in decompensated heart failure (HF). Hypothesis: We aimed to evaluate diagnostic and prognostic performance of bio-ADM for HF in comparison to amino-terminal pro-B-type natriuretic peptide (NT-proBNP), with decision thresholds derived from invasive hemodynamic and population-based studies. Methods and Results: Normal reference ranges (95% prediction interval) for bio-ADM were derived from a community-based cohort (n=5060): 8-39 pg/mL. In a cohort of HF patients undergoing right heart catheterization (n=346), bio-ADM was correlated with mean right atrial pressure (mRAP, r=0.55) and followed a concordant trajectory to mRAP after heart transplantation. In contrast, NT-proBNP was correlated with pulmonary arterial wedge pressure (PAWP). The area under the receiver operating characteristic curve (AUROC) for discrimination of elevated mRAP and PAWP was 0.74 (95%CI=0.67-0.79) and 0.70 (95%CI=0.64-0.75), respectively, with optimal bio-ADM decision cutoff of 39 pg/mL, concordant with cubic spline analyses. NT-proBNP discriminated PAWP slightly better than mRAP (AUROC 0.73 [95%CI=0.68-0.79] and 0.68 [95%CI=0.61-0.75]). In a cohort of patients presenting with acute dyspnea (n=1534), including patients with decompensated HF (n=570), a bio-ADM decision cutoff of 39 pg/mL was associated with 30- and 90-day mortality and conferred a 2-fold increased odds of HF diagnosis, independently from NT-proBNP. Conclusions: Bio-ADM tracks with mRAP and associates with measures of systemic congestion and with mortality in decompensated HF independently from NT-proBNP. Our findings support utility of bio-ADM as a biomarker of systemic venous congestion in HF and nominate a decision threshold.