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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2007;27:2037.)
© 2007 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Asymmetric Dimethylarginine Enhances Cardiovascular Risk Prediction in Patients With Chronic Heart Failure

Christina Dückelmann; Friedrich Mittermayer; Dominik Georg Haider; Johann Altenberger; Jörg Eichinger; Michael Wolzt

From the Department of Clinical Pharmacology (C.D., F.M., D.G.H., M.W.), Medical University of Vienna; the Pharmacy Department at the St. Johanns Spital (C.D.), Salzburg; and Department of Cardiology at the Salzburger Landeskliniken (J.A., J.E.), Private Paracelsus Medical University, Salzburg, Austria.

Correspondence to Michael Wolzt, MD, Department of Clinical Pharmacology, Allgemeines Krankenhaus Wien, A-1090 Wien, Währinger Gürtel 18-20. E-mail michael.wolzt{at}meduniwien.ac.at

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.

Elevated ADMA plasma concentrations are associated with adverse outcome in patients with chronic heart failure. After 6 months follow-up, a greater than 3.6-fold risk elevation for the occurrence of a clinical end point was demonstrable when both ADMA and NT-proBNP plasma concentrations were increased. There was no relationship between ADMA and NT-proBNP.

Key Words: asymmetrical dimethylarginine • heart failure • natriuretic peptides • risk factor

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