Heart 1998;79:39-44 ( January )

Increased plasma adrenomedullin levels in patients with acute myocardial infarction in proportion to the clinical severity

Yuji Miyao,^a Toshio Nishikimi,^b Yoichi Goto,^a Shunichi Miyazaki,^a Satoshi Daikoku,^a Isao Morii,^a Takahiro Matsumoto,^a Shuichi Takishita,^b Atsuro Miyata,^c Hisayuki Matsuo,^c Kenji Kangawa,^c Hiroshi Nonogi^a

^a Department of Internal Medicine, Division of Cardiology, National Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka 565, Japan, ^b Department of Internal Medicine, Division of Hypertension, National Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka 565, Japan, ^c National Cardiovascular Centre Research Institute, Suita, Osaka 565, Japan

Correspondence to: Dr Nishikimi, Department of Internal Medicine, Division of Hypertension and Nephrology, National Cardiovascular Centre, 5-7-1 Fujishirodai Suita, Osaka 565, Japan.

Accepted for publication 14 August 1997

ObjectivesTo investigate the pathophysiological role of adrenomedullin in myocardial infarction.
Patients and designPlasma concentrations of adrenomedullin, atrial natriuretic factor, and brain natriuretic peptide were measured by radioimmunoassay in 31 patients with acute myocardial infarction over four weeks, and in 44 normal subjects.
ResultsIn patients with acute myocardial infarction, plasma adrenomedullin reached a peak of (mean (SD) 14.0 (9.0) pmol/l at 24 hours after the onset of symptoms and remained increased at all sampling points except the four week point compared with the value in normal subjects (5.0 (2.0) pmol/l). Adrenomedullin concentrations on admission were higher in patients from Killip class II, III, and IV than class I, and correlated positively with peak plasma creatine kinase and left ventricular end diastolic volume index, and negatively with left ventricular ejection fraction. The values from 12 to 48 hours were negatively correlated with systemic vascular resistance index. During the time course studied, adrenomedullin concentrations were positively correlated with atrial natriuretic factor (r = 0.40, p < 0.001) and brain natriuretic peptide (r = 0.53, p < 0.001).
ConclusionsPlasma adrenomedullin concentrations increased in the acute phase of myocardial infarction in proportion with clinical severity, suggesting that adrenomedullin may play an important role in the pathophysiology of myocardial infarction.

Keywords: adrenomedullin;  acute myocardial infarction;  natriuretic peptides

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© 1998 by Heart
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