on June 14, 2007
Published online before print June 14, 2007, doi: 10.1161/ATVBAHA.107.147595
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Submitted on February 2, 2007
Accepted on May 24, 2007
Asymmetric Dimethylarginine Enhances Cardiovascular Risk Prediction in Patients With Chronic Heart Failure
Christina Dückelmann ;
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.
* To whom correspondence should be addressed. E-mail: michael.wolzt{at}meduniwien.ac.at.
Objective--The purpose of this study was to investigate whether elevated 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 probrain 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.
Key words: asymmetrical dimethylarginine • heart failure • natriuretic peptides • risk factor
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