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 journalArticleAcademicpeer-review


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 languageEnglish
Pages (from-to)e165-e181
JournalAmerican Journal of Medicine
Early online date1 Mar 2022
Publication statusPublished - Jul 2022

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