adrenomedullin and Cardio-Renal-Syndrome

Biomarkers are increaingly being used in the management of heart failure not only for the purpose of screening, diagnosis, and risk stratification, but also as a guide to evaluate the response to treatment in the individual patient and as an entry criterion and/or a surrogate marker of efficacy in clinical trials testing novel drugs. In this chapter, we review the role of established biomarkers for heart failure management, according to the main classification of HF phenotypes, based on the measurement of left ventricular ejection fraction, including heart failure with reduced (<40%), preserved (≥50%), and, as recently proposed, mid-range (40-49%) ejection fraction.

Topics: Adrenomedullin; Aldosterone; Angiotensin II; Atrial Natriuretic Factor; beta-N-Acetyl-Galactosaminidase; Biomarkers; C-Reactive Protein; Cardio-Renal Syndrome; Catecholamines; Chromogranin A; Creatinine; Galectin 3; Glycopeptides; Growth Differentiation Factor 15; Heart Failure; Hepatitis A Virus Cellular Receptor 1; Humans; Interleukin-1; Interleukin-1 Receptor-Like 1 Protein; Interleukin-18; Interleukin-6; Lipocalin-2; MicroRNAs; Natriuretic Peptide, Brain; Peptide Fragments; Renin; Renin-Angiotensin System; Stroke Volume; Troponin; Troponin T; Tumor Necrosis Factor-alpha

To evaluate whether plasma adrenomedullin is involved in the previously reported significant inverse correlation between left ventricular (LV) end-diastolic pressure (peak velocity of early transmitral flow/peak velocity of early diastolic mitral annular motion ratio [E/E' ]) and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus, mild-to-moderate renal function impairment and LV relaxation impairment (E'≤7.1 cm/s).. Plasma adrenomedullin concentration, E/E' and eGFR were assessed in 82 patients with type 2 diabetes.. Plasma adrenomedullin concentration was positively correlated with eGFR in patients with or without LV relaxation impairment, and inversely correlated with E/E' in patients with LV relaxation impairment. Multivariate linear regression analysis supported a role for plasma adrenomedullin in the association between E/E' and eGFR.. These results support the hypothesis that adrenomedullin modulates the interaction between the heart and kidneys in early subclinical cardiorenal syndrome in patients with type 2 diabetes mellitus.

Topics: Adrenomedullin; Aged; Cardio-Renal Syndrome; Diabetes Mellitus, Type 2; Female; Glomerular Filtration Rate; Humans; Linear Models; Male; Middle Aged; Multivariate Analysis; Ventricular Dysfunction, Left