Bioactive Adrenomedullin for Assessment of Venous Congestion in Heart Failure

Figures

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  Figure 1. Bio‐ADM distribution across cohorts. Distribution of bioactive adrenomedullin (bio‐ADM) in the three study cohorts. For all cohorts, the dashed line indicates the upper reference threshold based on the MPP cohort (39 pg/mL), which also corresponds to the decision cutoff for elevated mRAP. (A) The community‐based MPP cohort distribution of bio‐ADM in the entire cohort (n = 5060, yellow) and healthy subcohort (n = 1128, blue). Truncation of the distribution was observed at the lower limit of detection (8 pg/mL). A normal reference interval was derived from 2.5 and 97.5 percentiles through bootstrap resampling (8 [95% CI 8–8] to 39.1 [95% CI 36.5–41.8] for entire cohort, 8 [95% CI 8–8] to 29.5 95% [CI 25.6–33.7]) in the healthy subcohort. Fourteen positive outliers were excluded from the plot (max. 283 pg/mL). The proportion of subjects over the cutoff of 39 pg/mL was 2.5% in the full cohort (127 subjects) and 1.1% (12 subjects) in the healthy subcohort. (B) Cohort of heart failure (HF) patients undergoing right heart catheterization (HF‐RHC). Distribution of bio‐ADM at baseline in the entire cohort (n = 346, yellow) and in a subset of patients after transplantation (n = 47, blue).…

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  Figure 2. Association of bio‐ADM with measures of congestion and outcomes. (A, B) Scatter plots depicting the relation of bio‐ADM with mean right atrial pressure (mRAP) and pulmonary arterial wedge pressure (PAWP) in patients with heart failure (HF) from the HF‐RHC cohort (n = 332). (C, D) Receiver‐operating characteristic (ROC) curves showing discrimination of elevated mRAP (>10 mmHg) and PAWP (>15 mmHg) with bio‐ADM (n = 332) and NT‐proBNP (n = 265). Cutoff 39 pg/mL indicated. (E) ROC curve showing discrimination of final heart failure diagnosis with NT‐proBNP and bio‐ADM in patients with acute dyspnoea from the ADYS cohort (n = 1534). (F) Kaplan–Meier curve illustrating 30 day mortality in decompensated heart failure patients (n = 570) with elevated bio‐ADM (>39 pg/mL) and NT‐proBNP (>1045 pg/mL).