This Article Full Text Full Text (PDF) Additional Materials All Versions of this Article: 28/5/954    most recent ATVBAHA.108.162768v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Zeller, M. Articles by Rochette, L. PubMed PubMed Citation Articles by Zeller, M. Articles by Rochette, L.

(Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28:954.)
© 2008 American Heart Association, Inc.

Clinical and Population Studies

Impact of Asymmetric Dimethylarginine on Mortality After Acute Myocardial Infarction

Marianne Zeller; Claudia Korandji; Jean-Claude Guilland; Pierre Sicard; Catherine Vergely; Luc Lorgis; Jean-Claude Beer; Laurence Duvillard; Anne-Cécile Lagrost; Daniel Moreau; Philippe Gambert; Yves Cottin; Luc Rochette

From the Laboratory of Experimental Cardiovascular Pathophysiology and Pharmacology (M.Z., C.K., J.-C.G., P.S., C.V., A.-C.L., D.M., Y.C., L.R.), Faculties of Medicine and Pharmacy, University of Burgundy; Neurotransmitters and Vitamin Laboratory (J.-C.G.), General Hospital; Cardiology Department (L.L., J.-C.B., Y.C.), University Hospital; and the Biochemistry Department (L.D., P.G.), University Hospital, Dijon, France.

Correspondence to Marianne Zeller, Laboratory of Experimental Cardiovascular Pathophysiology and Pharmacology, IFR100 santé- STIC, Faculties of Medicine and Pharmacy, University of Burgundy, 21079 Dijon Cedex, France. E-mail marianne.zeller{at}u-bourgogne.fr

Abstract

Objective— Asymmetrical dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide (NO) synthases. From a prospective cohort of patients with acute myocardial infarction (MI), we aimed to analyze the predictive value of circulating ADMA concentrations on prognosis.

Methods and Results— Blood samples from 249 consecutive patients hospitalized for acute MI <24 hours were taken on admission. Serum levels of ADMA and its stereoisomer, symmetrical dimethylarginine (SDMA), were determined using high-performance liquid chromatography. The independent predictors of ADMA were glomerular filtration rate, female sex, and SDMA (R²=0. 25). Baseline ADMA levels were higher in patients who had died than in patients who were alive at 1 year follow-up (1.23 [0.98 to 1.56] versus 0.95 [0.77 to 1.20] µmol/L, P<0.001). By Cox multivariate analysis, the higher tertile of ADMA (median [interquartile range]: 1.45 [1.24 to 1.70] µmol/L) was a predictor for mortality (Hazard Ratio [95% CI], 4.83 [1.59 to 14.71]), when compared to lower tertiles, even when adjusted for potential confounders, such as acute therapy, biological, and clinical factors.

Conclusion— Our study suggests that the baseline ADMA level has a strong prognostic value for mortality after MI, beyond traditional risk factors and biomarkers.

From patients with acute myocardial infarction (MI), we analyzed the levels of circulating asymmetrical dimethylarginine (ADMA). High ADMA was a predictor for mortality, even when adjusted for potential confounders. Our study suggests that ADMA has a prognostic value for mortality after MI, beyond traditional risk factors and biomarkers.

Key Words: ADMA • myocardial infarction • prognosis