Biologically Active Adrenomedullin (bio-ADM) is of potential value in identifying congestion and selecting patients for neurohormonal blockade in acute dyspnea

Justas Simonavičius; Aurimas Mikalauskas; Kamilė Čerlinskaitė; Etienne Gayat; Vytautas Juknevičius; Eglė Palevičiūtė; Irina Alitoit-Marrote; Denis Kablučko; Loreta Bagdonaitė; Mindaugas Balčiūnas; Dovilė Vaičiulienė; Ieva Jonauskienė; Justina Motiejūnaitė; Kęstutis Stašaitis; Audrys Kukulskis; Šarūnas Damalakas; Toma Šimbelytė; Neringa Taparauskaitė; Gintarė Pukanasienė; Aleksandras Laucevičius; Aušra Kavoliūnienė; Alexandre Mebazaa; Jelena Čelutkienė; GREAT network

doi:10.1016/j.amjmed.2022.02.006

Biologically Active Adrenomedullin (bio-ADM) is of potential value in identifying congestion and selecting patients for neurohormonal blockade in acute dyspnea

Justas Simonavičius^*, Aurimas Mikalauskas, Kamilė Čerlinskaitė, Etienne Gayat, Vytautas Juknevičius, Eglė Palevičiūtė, Irina Alitoit-Marrote, Denis Kablučko, Loreta Bagdonaitė, Mindaugas Balčiūnas, Dovilė Vaičiulienė, Ieva Jonauskienė, Justina Motiejūnaitė, Kęstutis Stašaitis, Audrys Kukulskis, Šarūnas Damalakas, Toma Šimbelytė, Neringa Taparauskaitė, Gintarė Pukanasienė, Aleksandras LaucevičiusAušra Kavoliūnienė, Alexandre Mebazaa, Jelena Čelutkienė, GREAT network

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

PURPOSE: . This study was designed to evaluate the role of bio-ADM in congestion assessment and risk stratification in acute dyspnea.

METHODS: . This is a sub-analysis of Lithuanian Echocardiography Study of Dyspnea in Acute Settings. Congestion was assessed by means of clinical (peripheral oedema, rales) and sonographic (estimated right atrial pressure [eRAP]) parameters. Ninety-day mortality was chosen for outcome analysis.

RESULTS: . 1188 patients were included. Bio-ADM concentration was higher in patients with peripheral oedema at admission (48.2 [28.2-92.6] vs 35.4 [20.9-59.2] ng/L, p<0.001). There was a stepwise increase in bio-ADM concentration with increasing prevalence of rales: 29.8 [18.8-51.1], 38.5 [27.5-67.1], and 51.1 [33.1-103.2] ng/L in patients with no rales, rales covering < ½, and ≥ ½ of the pulmonary area, respectively (p<0.001). Bio-ADM concentration demonstrated gradual elevation in patients with normal, moderately, and severely increased eRAP: 25.1 [17.6-42.4] ng/L, 36.1 [23.1-50.2] and 47.1 [30.7-86.7] ng/L, respectively (p<0.05). Patients with bio-ADM concentration > 35.5 ng/L were at more than two-fold increased risk of dying (p<0.001). Survival in those with high bio-ADM was significantly modified by neurohormonal blockade at admission (p<0.05), especially if NT-proBNP levels were lower than the median (p = 0.002 for interaction).

CONCLUSION: . Bio-ADM reflects the presence and the degree of pulmonary, peripheral, and intravascular volume overload and is strongly related to 90-day mortality in acute dyspnea. Patients with high bio-ADM levels demonstrated survival benefit from neurohormonal blockade.

Original language	English
Pages (from-to)	e165-e181
Number of pages	17
Journal	American Journal of Medicine
Volume	135
Issue number	7
Early online date	1 Mar 2022
DOIs	https://doi.org/10.1016/j.amjmed.2022.02.006
Publication status	Published - Jul 2022

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10.1016/j.amjmed.2022.02.006

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Simonavičius, J., Mikalauskas, A., Čerlinskaitė, K., Gayat, E., Juknevičius, V., Palevičiūtė, E., Alitoit-Marrote, I., Kablučko, D., Bagdonaitė, L., Balčiūnas, M., Vaičiulienė, D., Jonauskienė, I., Motiejūnaitė, J., Stašaitis, K., Kukulskis, A., Damalakas, Š., Šimbelytė, T., Taparauskaitė, N., Pukanasienė, G., ... GREAT network (2022). Biologically Active Adrenomedullin (bio-ADM) is of potential value in identifying congestion and selecting patients for neurohormonal blockade in acute dyspnea. American Journal of Medicine, 135(7), e165-e181. https://doi.org/10.1016/j.amjmed.2022.02.006

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title = "Biologically Active Adrenomedullin (bio-ADM) is of potential value in identifying congestion and selecting patients for neurohormonal blockade in acute dyspnea",

abstract = "PURPOSE: . This study was designed to evaluate the role of bio-ADM in congestion assessment and risk stratification in acute dyspnea.METHODS: . This is a sub-analysis of Lithuanian Echocardiography Study of Dyspnea in Acute Settings. Congestion was assessed by means of clinical (peripheral oedema, rales) and sonographic (estimated right atrial pressure [eRAP]) parameters. Ninety-day mortality was chosen for outcome analysis.RESULTS: . 1188 patients were included. Bio-ADM concentration was higher in patients with peripheral oedema at admission (48.2 [28.2-92.6] vs 35.4 [20.9-59.2] ng/L, p<0.001). There was a stepwise increase in bio-ADM concentration with increasing prevalence of rales: 29.8 [18.8-51.1], 38.5 [27.5-67.1], and 51.1 [33.1-103.2] ng/L in patients with no rales, rales covering < ½, and ≥ ½ of the pulmonary area, respectively (p<0.001). Bio-ADM concentration demonstrated gradual elevation in patients with normal, moderately, and severely increased eRAP: 25.1 [17.6-42.4] ng/L, 36.1 [23.1-50.2] and 47.1 [30.7-86.7] ng/L, respectively (p<0.05). Patients with bio-ADM concentration > 35.5 ng/L were at more than two-fold increased risk of dying (p<0.001). Survival in those with high bio-ADM was significantly modified by neurohormonal blockade at admission (p<0.05), especially if NT-proBNP levels were lower than the median (p = 0.002 for interaction).CONCLUSION: . Bio-ADM reflects the presence and the degree of pulmonary, peripheral, and intravascular volume overload and is strongly related to 90-day mortality in acute dyspnea. Patients with high bio-ADM levels demonstrated survival benefit from neurohormonal blockade.",

author = "Justas Simonavi{\v c}ius and Aurimas Mikalauskas and Kamilė {\v C}erlinskaitė and Etienne Gayat and Vytautas Juknevi{\v c}ius and Eglė Palevi{\v c}iūtė and Irina Alitoit-Marrote and Denis Kablu{\v c}ko and Loreta Bagdonaitė and Mindaugas Bal{\v c}iūnas and Dovilė Vai{\v c}iulienė and Ieva Jonauskienė and Justina Motiejūnaitė and K{\c e}stutis Sta{\v s}aitis and Audrys Kukulskis and {\v S}arūnas Damalakas and Toma {\v S}imbelytė and Neringa Taparauskaitė and Gintarė Pukanasienė and Aleksandras Laucevi{\v c}ius and Au{\v s}ra Kavoliūnienė and Alexandre Mebazaa and Jelena {\v C}elutkienė and {GREAT network}",

note = "Copyright {\textcopyright} 2022. Published by Elsevier Inc.",

year = "2022",

month = jul,

doi = "10.1016/j.amjmed.2022.02.006",

language = "English",

volume = "135",

pages = "e165--e181",

journal = "American Journal of Medicine",

issn = "0002-9343",

publisher = "Elsevier Science",

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Simonavičius, J, Mikalauskas, A, Čerlinskaitė, K, Gayat, E, Juknevičius, V, Palevičiūtė, E, Alitoit-Marrote, I, Kablučko, D, Bagdonaitė, L, Balčiūnas, M, Vaičiulienė, D, Jonauskienė, I, Motiejūnaitė, J, Stašaitis, K, Kukulskis, A, Damalakas, Š, Šimbelytė, T, Taparauskaitė, N, Pukanasienė, G, Laucevičius, A, Kavoliūnienė, A, Mebazaa, A, Čelutkienė, J & GREAT network 2022, 'Biologically Active Adrenomedullin (bio-ADM) is of potential value in identifying congestion and selecting patients for neurohormonal blockade in acute dyspnea', American Journal of Medicine, vol. 135, no. 7, pp. e165-e181. https://doi.org/10.1016/j.amjmed.2022.02.006

Biologically Active Adrenomedullin (bio-ADM) is of potential value in identifying congestion and selecting patients for neurohormonal blockade in acute dyspnea. / Simonavičius, Justas; Mikalauskas, Aurimas; Čerlinskaitė, Kamilė et al.
In: American Journal of Medicine, Vol. 135, No. 7, 07.2022, p. e165-e181.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Biologically Active Adrenomedullin (bio-ADM) is of potential value in identifying congestion and selecting patients for neurohormonal blockade in acute dyspnea

AU - Simonavičius, Justas

AU - Mikalauskas, Aurimas

AU - Čerlinskaitė, Kamilė

AU - Gayat, Etienne

AU - Juknevičius, Vytautas

AU - Palevičiūtė, Eglė

AU - Alitoit-Marrote, Irina

AU - Kablučko, Denis

AU - Bagdonaitė, Loreta

AU - Balčiūnas, Mindaugas

AU - Vaičiulienė, Dovilė

AU - Jonauskienė, Ieva

AU - Motiejūnaitė, Justina

AU - Stašaitis, Kęstutis

AU - Kukulskis, Audrys

AU - Damalakas, Šarūnas

AU - Šimbelytė, Toma

AU - Taparauskaitė, Neringa

AU - Pukanasienė, Gintarė

AU - Laucevičius, Aleksandras

AU - Kavoliūnienė, Aušra

AU - Mebazaa, Alexandre

AU - Čelutkienė, Jelena

AU - GREAT network

PY - 2022/7

Y1 - 2022/7

N2 - PURPOSE: . This study was designed to evaluate the role of bio-ADM in congestion assessment and risk stratification in acute dyspnea.METHODS: . This is a sub-analysis of Lithuanian Echocardiography Study of Dyspnea in Acute Settings. Congestion was assessed by means of clinical (peripheral oedema, rales) and sonographic (estimated right atrial pressure [eRAP]) parameters. Ninety-day mortality was chosen for outcome analysis.RESULTS: . 1188 patients were included. Bio-ADM concentration was higher in patients with peripheral oedema at admission (48.2 [28.2-92.6] vs 35.4 [20.9-59.2] ng/L, p<0.001). There was a stepwise increase in bio-ADM concentration with increasing prevalence of rales: 29.8 [18.8-51.1], 38.5 [27.5-67.1], and 51.1 [33.1-103.2] ng/L in patients with no rales, rales covering < ½, and ≥ ½ of the pulmonary area, respectively (p<0.001). Bio-ADM concentration demonstrated gradual elevation in patients with normal, moderately, and severely increased eRAP: 25.1 [17.6-42.4] ng/L, 36.1 [23.1-50.2] and 47.1 [30.7-86.7] ng/L, respectively (p<0.05). Patients with bio-ADM concentration > 35.5 ng/L were at more than two-fold increased risk of dying (p<0.001). Survival in those with high bio-ADM was significantly modified by neurohormonal blockade at admission (p<0.05), especially if NT-proBNP levels were lower than the median (p = 0.002 for interaction).CONCLUSION: . Bio-ADM reflects the presence and the degree of pulmonary, peripheral, and intravascular volume overload and is strongly related to 90-day mortality in acute dyspnea. Patients with high bio-ADM levels demonstrated survival benefit from neurohormonal blockade.

AB - PURPOSE: . This study was designed to evaluate the role of bio-ADM in congestion assessment and risk stratification in acute dyspnea.METHODS: . This is a sub-analysis of Lithuanian Echocardiography Study of Dyspnea in Acute Settings. Congestion was assessed by means of clinical (peripheral oedema, rales) and sonographic (estimated right atrial pressure [eRAP]) parameters. Ninety-day mortality was chosen for outcome analysis.RESULTS: . 1188 patients were included. Bio-ADM concentration was higher in patients with peripheral oedema at admission (48.2 [28.2-92.6] vs 35.4 [20.9-59.2] ng/L, p<0.001). There was a stepwise increase in bio-ADM concentration with increasing prevalence of rales: 29.8 [18.8-51.1], 38.5 [27.5-67.1], and 51.1 [33.1-103.2] ng/L in patients with no rales, rales covering < ½, and ≥ ½ of the pulmonary area, respectively (p<0.001). Bio-ADM concentration demonstrated gradual elevation in patients with normal, moderately, and severely increased eRAP: 25.1 [17.6-42.4] ng/L, 36.1 [23.1-50.2] and 47.1 [30.7-86.7] ng/L, respectively (p<0.05). Patients with bio-ADM concentration > 35.5 ng/L were at more than two-fold increased risk of dying (p<0.001). Survival in those with high bio-ADM was significantly modified by neurohormonal blockade at admission (p<0.05), especially if NT-proBNP levels were lower than the median (p = 0.002 for interaction).CONCLUSION: . Bio-ADM reflects the presence and the degree of pulmonary, peripheral, and intravascular volume overload and is strongly related to 90-day mortality in acute dyspnea. Patients with high bio-ADM levels demonstrated survival benefit from neurohormonal blockade.

U2 - 10.1016/j.amjmed.2022.02.006

DO - 10.1016/j.amjmed.2022.02.006

M3 - Article

C2 - 35245495

SN - 0002-9343

VL - 135

SP - e165-e181

JO - American Journal of Medicine

JF - American Journal of Medicine

IS - 7

ER -