Proadrenomedullin in Patients with Preserved Left Ventricular Systolic Function Undergoing Coronary Artery Bypass Grafting

Abstract

Introduction: A potentially new marker of cardiovascular diseases - proadrenomedullin is the precursor of adrenomedullin, which is a multifunctional peptide hormone, produced in most of the tissues in response to cellular stress, ischemia, and hypoxia.

Methods: Ninety-three people, aged 51-79 years, were included in the study. Exclusion criteria were severe or corrected valvular disease, acute coronary syndrome, age ≥ 80 years, glomerular filtration rate < 45 ml/min, active infectious diseases, and cancer. The subjects were observed for adverse events, including reduced left ventricular ejection fraction (LVEF) by ≥ 10%, first incidence of atrial fibrillation (AF), and the necessity of using dopamine during hospitalization.

Results: Use of pressure amines, occurrence of the first AF episode, and left ventricular dysfunction defined by a decrease in LVEF by at least 10% compared to the value before surgery were reported in the perioperative period. No death, sudden cardiac arrest with effective resuscitation, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction, or heart failure were observed. Significantly higher proadrenomedullin concentration was observed in the group with reduced postoperative LVEF (1.68 vs. 0.77 nmol/l, P=0.005). The relative risk of a decrease in ejection fraction in the group of patients with proadrenomedullin concentration ≥ 0.77 nmol/l was more than twelve-fold higher (95% confidence interval 1.69-888.33; P=0.013) than in the group of patients with a concentration of proadrenomedullin < 0.77 nmol/l.

Conclusion: The higher baseline concentration of proadrenomedullin has a predominantly predictive value of postoperative left ventricular systolic dysfunction.

Keywords: Biomarker; Coronary Artery Bypass; Perioperative Period; Proadrenomedullin; ST Elevation Myocardial Infarctation; Systolic Function.

Fig. 1

Schematic representation of the proadrenomedullin (proADM) gene^[2]. DNA=deoxyribonucleic acid; MR-proADM=middle fragment of proadrenomedullin; PAMP=proadrenomedullin N-terminal 20 peptide.

Fig. 2

Comparison of patients with a significant decrease in left ventricular ejection fraction (LVEF) ≥ 10% and patients with preserved ejection fraction in proadrenomedullin (proADM) concentration.

Fig. 3

Receiver operating characteristic curve for a decrease in ejection fraction. AUC=area under the curve; proADM=proadrenomedullin.