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Plasma asymmetric dimethylarginine and mortality in patients with acute decompensation of chronic heart failure
  1. Michael N Zairis1,
  2. Nikoloas G Patsourakos1,
  3. George Z Tsiaousis1,
  4. Anastassios Theodossis Georgilas1,
  5. Andreas Melidonis1,
  6. Stamatis S Makrygiannis1,
  7. Dimitrios Velissaris2,
  8. Pelagia C Batika1,
  9. Kyriakos S Argyrakis1,
  10. Stavros P Tzerefos1,
  11. Athanasios A Prekates1,
  12. Stefanos G Foussas1
  1. 1Department of Cardiology, Tzanio Hospital, Piraeus, Greece
  2. 2Department of Anaesthesiology and Critical Care Medicine, University Hospital of Patras, Rion, Greece
  1. Correspondence to Dr Michael N Zairis, Koletti 56, Piraeus, 18537, Greece; zairis66{at}


Objectives To investigate the prognostic value of circulating levels of asymmetric dimethylarginine (ADMA) in patients with acute decompensation of (New York Heart Association (NYHA) class III/IV) chronic heart failure and reduced left ventricular ejection fraction.

Design Single-centre prospective observational study.

Setting Tertiary referral centre.

Patients A total of 651 consecutive and eligible hospitalised patients were studied. Patients were divided into four groups according to the quartiles of circulating levels of ADMA upon presentation.

Main outcome measures Incidence of in-hospital (or 7-day in the case of prolonged hospitalisation), 31-day and 1-year cardiac mortality were the pre-specified study end points.

Results Cumulative rates of in-hospital, 31-day and 1-year cardiac mortality were 10.6%, 18.7% and 36.4%, respectively. There was a gradual increased risk of in-hospital (pfor trend=0.011), 31-day (pfor trend=0.044) and 1-year (pfor trend<0.001) mortality with increasing ADMA quartiles. After adjustment for possible confounders, patients at the highest ADMA quartile were at significantly higher risk for in-hospital (p=0.042), 31-day (p=0.032) and 1-year (p<0.001) mortality than those in the lowest quartile.

Conclusions According to the present results, an elevated circulating level of ADMA is a strong independent predictor of short-term and long-term mortality in patients with acute decompensation of NYHA class III/IV chronic heart failure and reduced left ventricular ejection fraction. ADMA levels upon presentation may confer enhanced risk stratification in this setting.

  • Asymmetric dimethylarginine
  • heart failure
  • acute decompensation
  • mortality
  • prognosis
  • intensive care
  • myocardial ischaemia and infarction (IHD)
  • Brugada

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  • See Editorial, p 831

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The ethics committee of Tzanio Hospital.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement We have complied with the data sharing policy and no additional data exist.

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