Increase in plasma adrenomedullin in patients with heart failure characterised by diastolic dysfunction

Abstract

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 (X 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 nonrestrictive filling pattern (group 3, n = 30) (mean (SEM): 91.7 (21.1) v 38.4 (8.8) v 34.0 (6.5) pmol/1, both p < 0.05). All heart failure values were higher (p < 0.01) than the control value (6.9 (1.2) pmol/1). 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.