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Heart 2001;86:155-160; doi:10.1136/heart.86.2.155
Copyright © 2001 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 2001;86:155-160 ( August )

Cardiovascular medicine

Increase in plasma adrenomedullin in patients with heart failure characterised by diastolic dysfunction C-M Yu, B M Y Cheung, R Leung, Q Wang, W-H Lai, C-P Lau

Department of Medicine, Queen Mary Hospital and the Institute of Cardiovascular Science and Medicine, University of Hong Kong, Pokfulam Road, Hong Kong

Correspondence to: Dr Yu cmyua{at}hkucc.hku.hk

Accepted 28 March 2001

OBJECTIVE---To investigate the relation between plasma adrenomedullin and the severity of diastolic dysfunction in patients with heart failure.
DESIGN---Prospective study.
SETTING---University teaching hospital.
PATIENTS---77 patients (mean (SEM) age 66.3 (1.2) years; 75% male) who were being followed in the outpatient clinic after admission to hospital for acute heart failure.
INTERVENTIONS---Same day echocardiography with Doppler studies; determination of venous adrenomedullin concentration by radioimmunoassay.
MAIN OUTCOME MEASURES---Plasma adrenomedullin concentration and its correlation with systolic and diastolic function.
RESULTS---31 patients (40%) had isolated diastolic dysfunction (ejection fraction > 50%), and the remaining 46 had a depressed ejection fraction (< 50%). Of the patients with diastolic dysfunction, 17 had a restrictive filling pattern. In all but one of these there was coexisting systolic failure (chi 2 = 10.7, p = 0.001). Patients with systolic heart failure and a restrictive filling pattern (group 1, n = 16) had a higher plasma adrenomedullin than those with systolic failure and a non-restrictive filling pattern (group 2, n = 30) or with isolated diastolic heart failure and a non-restrictive filling pattern (group 3, n = 30) (mean (SEM): 91.7 (21.1) v 38.4 (8.8) v 34.0 (6.5) pmol/l, both p < 0.05). All heart failure values were higher (p < 0.01) than the control value (6.9 (1.2) pmol/l). Ejection fraction and left ventricular dimensions were similar in groups 1 and 2. Plasma adrenomedullin did not correlate with ejection fraction or New York Heart Association functional class. Stepwise multiple regression analysis showed that the presence of a restrictive filling pattern was the only independent variable associated with a high plasma adrenomedullin.
CONCLUSIONS---Plasma adrenomedullin concentrations in patients with heart failure are determined by the presence of diastolic dysfunction, and are especially raised in the presence of a restrictive filling pattern. There appears to be no correlation with systolic dysfunction.


Keywords: adrenomedullin; heart failure; diastolic dysfunction; Doppler echocardiography

© 2001 by Heart
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