| Authors |
Voordes, Geert ; Davison, Beth ; Biegus, Jan ; Edwards, Christopher ; Damman, Kevin ; ter Maaten, Jozine ; Mebazaa, Alexandre ; Takagi, Koji ; Adamo, Marianna ; Ambrosy, Andrew P ; Arrigo, Mattia ; Barros, Marianela ; Čelutkienė, Jelena ; Čerlinskaitė-Bajorė, Kamilė ; Chioncel, Ovidiu ; Cohen-Solal, Alain ; Damasceno, Albertino ; Deniau, Benjamin ; Diaz, Rafael ; Filippatos, Gerasimos ; Gayat, Etienne ; Kimmoun, Antoine ; Lam, Carolyn S.P ; Metra, Marco ; Novosadova, Maria ; Pagnesi, Matteo ; Pang, Peter ; Ponikowski, Piotr ; Saidu, Hadiza ; Sliwa, Karen ; Tomasoni, Daniela ; Cotter, Gad ; Voors, Adriaan A |
| Abstract [eng] |
Aims: Biologically active adrenomedullin (bio-ADM) is a promising marker of residual congestion. The STRONG-HF trial showed that high-intensity care (HIC) of guideline-directed medical therapy (GDMT) improved congestion and clinical outcomes in heart failure (HF) patients. The association between bio-ADM, decongestion, outcomes and the effect size of HIC of GDMT remains to be elucidated. Methods and results: We measured plasma bio-ADM concentrations in 1005 patients within 2 days prior to anticipated discharge (baseline) and 90 days later. Bio-ADM correlated with most signs of congestion, with the exception of rales. Changes in bio-ADM were strongly correlated with change in congestion status from baseline to day 90 (gamma −0.24; p = 0.0001). Patients in the highest tertile of baseline bio-ADM concentrations were at greater risk than patients in the lowest tertile for the primary outcome of 180-day all-cause mortality or HF rehospitalization (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.42–3.22) and 180-day HF rehospitalization (HR 2.33, 95% CI 1.38–3.94). Areas under the receiver-operating characteristic curves were 0.5977 (95% CI 0.5561–0.6393), 0.5800 (95% CI 0.5356–0.6243), and 0.6159 (95% CI 0.5711–0.6607) for bio-ADM, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and their combination, respectively, suggesting that both bio-ADM and NT-proBNP provided similarly modest discrimination for this outcome. A trend towards better discrimination by combined bio-ADM and NT-proBNP than NT-proBNP alone was found (p = 0.059). HIC improved the primary outcome, irrespective of baseline bio-ADM concentration (interaction p = 0.37). In contrast to NT-proBNP, the 90-day change in bio-ADM did not differ significantly between HIC and usual care. Conclusions: Bio-ADM is a marker of congestion and predicts congestion at 3 months after a HF hospitalization. Higher bio-ADM was modestly associated with a higher risk of death and early hospital readmission and may have added value when combined with NT-proBNP. |
