Mid-regional pro-adrenomedullin as a novel predictor of mortality in patients with chronic heart failure

Stephan Von Haehling, Gerasimos S. Filippatos, Jana Papassotiriou, Mariantonietta Cicoira, Ewa A. Jankowska, Wolfram Doehner, Piotr Rozentryt, Corrado Vassanelli, Joachim Struck, Waldemar Banasiak, Piotr Ponikowski, Dimitrios Kremastinos, Andreas Bergmann, Nils G. Morgenthaler, Stefan D. Anker

Research output: Contribution to journalArticlepeer-review


Aims: Adrenomedullin (ADM) is a vasodilatory peptide. Its plasma levels or its precursors have not been evaluated in large populations of patients with chronic heart failure (CHF). We sought to explore mid-regional proADM (MR-proADM). Methods and results: We assessed MR-proADM in 501 CHF patients [age 63±11 years, New York Heart Association (NYHA) class I/II/III/IV 9/44/39/8%, median N-terminal pro-B-type natriuretic peptide (NT-proBNP) 878 pg/mL (interquartile range-IQR 348-2480 pg/mL), median left ventricular ejection fraction (LVEF) 31% (IQR 25-37%)]. Mid-regional pro-adrenomedullin levels (median 0.64 nmol/L, IQR 0.49-0.87 nmol/L) increased with NYHA class (P <0.0001). During 1-year follow-up, 70 patients (14%) died. Increasing MR-proADM was a predictor of poor survival at 12 months (hazard ratio 1.82, 95% confidence interval 1.24-2.66, P = 0.002) after multivariable adjustment. In receiver-operating characteristic curve analysis of 12-month survival, the area under the curve for MR-proADM and NT-proBNP was similar (P = 0.3). Comparison of Cox proportional hazard models using the likelihood ratio χ 2 statistic showed that both NT-proBNP and MR-proADM added prognostic value to a base model of LVEF, age, creatinine, and NYHA class. Adding MR-proADM to the base model had stronger prognostic power than adding NT-proBNP (both P <0.01). Conclusion: Mid-regional pro-adrenomedullin is an independent predictor of mortality in CHF patients, which adds prognostic information to NT-proBNP.

Original languageEnglish
Pages (from-to)484-491
Number of pages8
JournalEuropean Journal of Heart Failure
Issue number5
Publication statusPublished - May 2010


  • Adrenomedullin
  • Biomarker
  • Heart failure
  • Pro-adrenomedullin
  • Prognosis

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine


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