ADMA concentrations in the highest tertile increased the risk of cardiac decompensation, MACE, or mortality compared to the lowest tertile (HR 2.00; 95% CI 1.01-3.97; P=0.046).
Cohort (n=253)
Are elevated asymmetrical dimethylarginine (ADMA) concentrations associated with increased cardiovascular risk in patients with symptomatic chronic heart failure?
Elevated ADMA plasma concentrations, particularly when combined with NT-proBNP, significantly improve risk stratification for adverse cardiovascular outcomes in patients with chronic heart failure.
Effect estimate: HR 2.00 (95% CI 1.01 to 3.97)
p-value: p=0.046
OBJECTIVE: The purpose of this study was to investigate whether elevated asymmetrical dimethylorginine (ADMA) concentrations are associated with increased cardiovascular risk in chronic heart failure (HF) patients. METHODS AND RESULTS: 253 patients with symptomatic chronic HF and impaired left ventricular function (median age 70 years, 202 males) were followed for a median of 14.2 months (interquartile range 6.8 to 21.2). ADMA and N-terminal pro-brain natriuretic peptide (NT-proBNP) were assessed by high performance liquid chromatography and by an enzyme-linked immunosorbent assay, respectively. Subjects with ADMA concentrations in the highest tertile had a significantly higher adjusted hazard ratio (HR; 2.00; 95% confidence interval CI 1.01 to 3.97) for occurrence of an end point (cardiac decompensation, major adverse cardiovascular events or all-cause mortality) compared with patients in the lowest tertile (P=0.046) during the first 6 months of follow-up. NT-proBNP also identified subjects at risk before adjustment for confounders at 6 and 12 months of follow-up. HR for patients with ADMA and NT-proBNP in the highest tertile was significantly increased (3.68, CI 1.67 to 8.14; at 6 months follow-up) compared with patients without ADMA and NT-proBNP in the highest tertile (P<0.001). CONCLUSIONS: Elevated ADMA plasma concentrations are associated with adverse cardiovascular outcome in patients with chronic HF. Quantification of ADMA with NT-proBNP improves risk stratification in this cohort.
Dückelmann et al. (Fri,) conducted a cohort in chronic heart failure (n=253). Highest tertile of ADMA concentrations vs. Lowest tertile of ADMA concentrations was evaluated on cardiac decompensation, major adverse cardiovascular events or all-cause mortality (HR 2.00, 95% CI 1.01 to 3.97, p=0.046). ADMA concentrations in the highest tertile increased the risk of cardiac decompensation, MACE, or mortality compared to the lowest tertile (HR 2.00; 95% CI 1.01-3.97; P=0.046).