Abstract
Objective Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide (NO) synthesis, is reported to be a risk factor for cardiovascular disease. The purpose of the present study is to investigate whether ADMA is an independent predictor for future mortality and adverse clinical events among patients with heart failure (HF). Methods Electronic literature databases (Central, MEDLINE, and Embase) were searched for relevant observational studies on the prognostic value of ADMA in HF patients published before January 2019. Pooled hazard ratios (HRs) or odds ratio and the corresponding 95% confidence interval (CI) were calculated for risk evaluation. Results 10 studies with 2195 participants were identified and analyzed. The pooled HR of composite clinical events for the highest vs. lowest quartiles from categorical variable results was 1.34 (95% CI: 1.15-1.57, P < 0.001, I2 = 0%), which is 1.31 (95% CI: 1.10-1.55, P < 0.005, I2 = 0%) in the subgroup of acute decompensated HF. The pooled HR of composite clinical events from continuous variable results was 1.41 (95% CI: 1.21-1.63, P < 0.001, I2 = 21.9%), with 0.1 μM increment accounting for the increasing 25% risk for composite adverse clinical events. The pooled HR for all-cause mortality was 2.38 (95% CI: 1.48-3.82, P < 0.001, I2 = 0%) after sensitivity analysis. Two studies reporting the HR of inhospital mortality in HF patients regarded it as a prognostic indicator, with categorical variable HR as 1.26 (95% CI: 1.07-1.84, P < 0.05) and continuous variable OR as 2.15 (95% CI: 1.17–4.29, P < 0.05). Conclusions ADMA is an independent predictor for composite clinical outcomes among HF patients with both short-term and long-term prognostic value.
Highlights
Heart failure (HF) is on the rise of the leading cause of death and hospitalization worldwide
We aim to provide a systematic review and meta-analysis to study the prognostic value of Asymmetric dimethylarginine (ADMA) in HF patients
Reported in different ways, both of them regarded ADMA as a prognostic indicator with hazard ratios (HRs) of highest quartile vs. lowest quartile as 1.26 and continuous variable OR as 2.15, demonstrating its value in assessing the short-term prognosis in HF patients
Summary
Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide (NO) synthesis, is reported to be a risk factor for cardiovascular disease. The purpose of the present study is to investigate whether ADMA is an independent predictor for future mortality and adverse clinical events among patients with heart failure (HF). The pooled HR of composite clinical events for the highest vs lowest quartiles from categorical variable results was 1.34 (95% CI: 1.15-1.57, P < 0:001, I2 = 0%), which is 1.31 (95% CI: 1.10-1.55, P < 0:005, I2 = 0%) in the subgroup of acute decompensated HF. Two studies reporting the HR of inhospital mortality in HF patients regarded it as a prognostic indicator, with categorical variable HR as 1.26 (95% CI: 1.07-1.84, P < 0:05) and continuous variable OR as 2.15 (95% CI: 1.17–4.29, P < 0:05). ADMA is an independent predictor for composite clinical outcomes among HF patients with both short-term and long-term prognostic value
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