TY - JOUR
T1 - Biologically active adrenomedullin as a marker for residual congestion and early rehospitalization in patients hospitalized for acute heart failure
T2 - Data from STRONG-HF
AU - Voordes, Geert
AU - Davison, Beth
AU - Biegus, Jan
AU - Edwards, Christopher
AU - Damman, Kevin
AU - ter Maaten, Jozine
AU - Mebazaa, Alexandre
AU - Takagi, Koji
AU - Adamo, Marianna
AU - Ambrosy, Andrew P.
AU - Arrigo, Mattia
AU - Barros, Marianela
AU - Celutkiene, Jelena
AU - Čerlinskaitė-Bajorė, Kamilė
AU - Chioncel, Ovidiu
AU - Cohen-Solal, Alain
AU - Damasceno, Albertino
AU - Deniau, Benjamin
AU - Diaz, Rafael
AU - Filippatos, Gerasimos
AU - Gayat, Etienne
AU - Kimmoun, Antoine
AU - Lam, Carolyn S.P.
AU - Metra, Marco
AU - Novosadova, Maria
AU - Pagnesi, Matteo
AU - Pang, Peter
AU - Ponikowski, Piotr
AU - Saidu, Hadiza
AU - Sliwa, Karen
AU - Tomasoni, Daniela
AU - Cotter, Gad
AU - Voors, Adriaan A.
N1 - Publisher Copyright:
© 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2024/7
Y1 - 2024/7
N2 - Aims: Biologically active adrenomedullin (bio-ADM) is a promising marker of residual congestion. The STRONG-HF trial showed that high-intensity care (HIC) of guideline-directed medical therapy (GDMT) improved congestion and clinical outcomes in heart failure (HF) patients. The association between bio-ADM, decongestion, outcomes and the effect size of HIC of GDMT remains to be elucidated. Methods and results: We measured plasma bio-ADM concentrations in 1005 patients within 2 days prior to anticipated discharge (baseline) and 90 days later. Bio-ADM correlated with most signs of congestion, with the exception of rales. Changes in bio-ADM were strongly correlated with change in congestion status from baseline to day 90 (gamma −0.24; p = 0.0001). Patients in the highest tertile of baseline bio-ADM concentrations were at greater risk than patients in the lowest tertile for the primary outcome of 180-day all-cause mortality or HF rehospitalization (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.42–3.22) and 180-day HF rehospitalization (HR 2.33, 95% CI 1.38–3.94). Areas under the receiver-operating characteristic curves were 0.5977 (95% CI 0.5561–0.6393), 0.5800 (95% CI 0.5356–0.6243), and 0.6159 (95% CI 0.5711–0.6607) for bio-ADM, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and their combination, respectively, suggesting that both bio-ADM and NT-proBNP provided similarly modest discrimination for this outcome. A trend towards better discrimination by combined bio-ADM and NT-proBNP than NT-proBNP alone was found (p = 0.059). HIC improved the primary outcome, irrespective of baseline bio-ADM concentration (interaction p = 0.37). In contrast to NT-proBNP, the 90-day change in bio-ADM did not differ significantly between HIC and usual care. Conclusions: Bio-ADM is a marker of congestion and predicts congestion at 3 months after a HF hospitalization. Higher bio-ADM was modestly associated with a higher risk of death and early hospital readmission and may have added value when combined with NT-proBNP.
AB - Aims: Biologically active adrenomedullin (bio-ADM) is a promising marker of residual congestion. The STRONG-HF trial showed that high-intensity care (HIC) of guideline-directed medical therapy (GDMT) improved congestion and clinical outcomes in heart failure (HF) patients. The association between bio-ADM, decongestion, outcomes and the effect size of HIC of GDMT remains to be elucidated. Methods and results: We measured plasma bio-ADM concentrations in 1005 patients within 2 days prior to anticipated discharge (baseline) and 90 days later. Bio-ADM correlated with most signs of congestion, with the exception of rales. Changes in bio-ADM were strongly correlated with change in congestion status from baseline to day 90 (gamma −0.24; p = 0.0001). Patients in the highest tertile of baseline bio-ADM concentrations were at greater risk than patients in the lowest tertile for the primary outcome of 180-day all-cause mortality or HF rehospitalization (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.42–3.22) and 180-day HF rehospitalization (HR 2.33, 95% CI 1.38–3.94). Areas under the receiver-operating characteristic curves were 0.5977 (95% CI 0.5561–0.6393), 0.5800 (95% CI 0.5356–0.6243), and 0.6159 (95% CI 0.5711–0.6607) for bio-ADM, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and their combination, respectively, suggesting that both bio-ADM and NT-proBNP provided similarly modest discrimination for this outcome. A trend towards better discrimination by combined bio-ADM and NT-proBNP than NT-proBNP alone was found (p = 0.059). HIC improved the primary outcome, irrespective of baseline bio-ADM concentration (interaction p = 0.37). In contrast to NT-proBNP, the 90-day change in bio-ADM did not differ significantly between HIC and usual care. Conclusions: Bio-ADM is a marker of congestion and predicts congestion at 3 months after a HF hospitalization. Higher bio-ADM was modestly associated with a higher risk of death and early hospital readmission and may have added value when combined with NT-proBNP.
KW - Acute heart failure
KW - Biologically active adrenomedullin
KW - Biomarker
KW - Residual congestion
KW - STRONG-HF
UR - http://www.scopus.com/inward/record.url?scp=85196058740&partnerID=8YFLogxK
U2 - 10.1002/ejhf.3336
DO - 10.1002/ejhf.3336
M3 - Article
C2 - 38874185
AN - SCOPUS:85196058740
SN - 1388-9842
VL - 26
SP - 1480
EP - 1492
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 7
ER -