Asymmetric Dimethyl Arginine is a Biomarker for Disease Stage and Follow-Up of Pulmonary Hypertension Associated with Congenital Heart Disease

作者：Fang, Zhen-fei; Huang, Yi-yuan; Tang, Liang; Hu, Xin-qun; Shen, Xiang-qian; Tang, Jian-jun; Zhou, Sheng-hua^*

来源：Pediatric Cardiology, 2015, 36(5): 1062-1069.

DOI：10.1007/s00246-015-1127-3

• Congenital heart disease
• Pulmonary arterial hypertension
• ADMA
• Eisenmenger syndrome
• Sildenafil

This study investigated the clinical value of plasma asymmetrical dimethyl-l-arginine (ADMA) level in the diagnosis, staging, and treatment response in congenital heart disease (CHD) patients with pulmonary arterial hypertension (PAH). This was a single-center prospective observational study in 80 CHD patients. Plasma ADMA levels were measured by enzyme-linked immunosorbent assay. Plasma ADMA levels were significantly increased in CHD patients with PAH compared with CHD patients without PAH (P < 0.01) and healthy controls (P < 0.001). In CHD patients with severe PAH, plasma ADMA levels were significantly higher in patients with Eisenmenger's syndrome (ES) than in patients exhibiting low pulmonary vascular resistance (P < 0.001). The plasma ADMA levels significantly correlated with pulmonary arterial pressure (P < 0.001) and pulmonary vascular resistance (P < 0.001) in patients with CHD. Severe PAH was identified by plasma ADMA with a cutoff value of 0.485 mu mol/L (P < 0.001) with a specificity of 82.8 % and a sensitivity of 90 %. ES was identified by plasma ADMA with a cutoff value of 0.85 mu mol/L (P < 0.05) with a specificity of 85.2 % and a sensitivity of 64.3 %. ADMA levels were significantly decreased after sildenafil therapy for 6 months compared with before therapy levels (0.91 +/- A 0.22 vs. 0.57 +/- A 0.30, P < 0.01). Our study suggests that plasma ADMA level may be used as a biomarker for identifying PAH in patients with CHD, assessing pulmonary vascular remodeling, and evaluating the treatment response of CHD patients with PAH to sildenafil.

• 出版日期2015-6
• 单位中南大学