Adrenomedullin Plasma Levels Predict Left Ventricular Reverse Remodeling after Cardiac Resynchronization Therapy

作者：Morales Maria Aurora^*; Maltinti Maristella; Piacenti Marcello; Turchi Stefano; Giannessi Daniela; Del Ry Silvia

来源：Pacing and Clinical Electrophysiology, 2010, 33(7): 865-872.

DOI：10.1111/j.1540-8159.2010.02723.x

• adrenomedullin
• natriuretic peptides
• cardiac resynchronization therapy
• heart failure

Methods: 50 patients, mean age 70 years, 34 male, New York Heart Association (NYHA) Class III-IV HF, left ventricular ejection fraction (LVEF) < 35%, underwent CRT. All patients were in sinus rhythm and with complete left bundle branch block (QRS duration 138 +/- 6 msec). A complete echoDoppler exam, blood samples for brain natriuretic peptide (BNP), and ADM were obtained from 2 to 7 days before implantation.
Results: At 16 +/- 6 months follow-up, >= 1 NYHA Class improvement was observed in 38 patients. However, a > 10% reduction in end-systolic dimensions (ESD) was reported in 21 patients (Group I): -16.6 +/- 1.8%; in the remaining 29 patients ESD change was almost negligible: -2.0 +/- 1.03% (Group II), P < 0.0001. The two groups were comparable for age, sex, cause of LV dysfunction, therapy, QRS duration at baseline, preimplantation ESD, LVEF%, and BNP. Significantly higher pre implantation ADM levels were present in Group I than in Group II (27.2 +/- 1.8 pmol/l vs 17.9 +/- 1.4, P = 0.0003).
Conclusions: Significantly higher ADM levels indicate a subgroup of patients in whom reverse remodeling can be observed after CRT. Patients with lower ADM basal values before CRT could represent a group in whom the dysfunction is so advanced that no improvement can be expected. (PACE 2010; 865-872).

• 出版日期2010-7