PMID- 35332049
OWN - NLM
STAT- MEDLINE
DCOM- 20220729
LR  - 20221113
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 108
IP  - 16
DP  - 2022 Jul 27
TI  - Novel predictive role for mid-regional proadrenomedullin in moderate to severe 
      aortic stenosis.
PG  - 1319-1327
LID - 10.1136/heartjnl-2021-320707 [doi]
AB  - OBJECTIVE: We investigated the prognostic significance of selected known and 
      novel circulating biomarkers in aortic stenosis (AS). METHODS: N-terminal pro-BNP 
      (NT-proBNP), high-sensitivity troponin-T (hsTnT), growth differentiation 
      factor-15 (GDF-15), suppression of tumorigenicity-2 (ST2), mid-regional 
      proadrenomedullin (MR-proADM) and mid-regional proatrial natriuretic peptide 
      (MR-proANP) were measured in patients with moderate to severe AS, New York Heart 
      Association (NYHA) class I-II and left ventricular ejection fraction >/=50%, 
      recruited consecutively across five centres from 2011 to 2018. Their ability to 
      predict both primary (all-cause mortality, heart failure hospitalisation or 
      progression to NYHA class III-IV) and secondary (additionally incorporating 
      syncope and acute coronary syndrome) outcomes was determined by competing risk 
      analyses. RESULTS: Among 173 patients with AS (age 69+/-11 years, 55% male, peak 
      transaortic velocity (Vmax) 4.0+/-0.8 m/s), the primary and secondary outcomes 
      occurred in 59 (34%) and 66 (38%), respectively. With aortic valve replacement as 
      a competing risk, the primary outcome was determined consistently by the 
      comorbidity index and each selected biomarker except ST2 (p<0.05), independent of 
      NYHA class, Vmax, LV-global longitudinal strain and serum creatinine. MR-proADM 
      had the highest discriminative value for both primary (subdistribution HR (SHR) 
      11.3, 95% CI 3.9 to 32.7) and secondary outcomes (SHR 12.6, 95% CI 4.7 to 33.5). 
      Prognostic assessment of dual-biomarker combinations identified MR-proADM plus 
      either hsTnT or NT-proBNP as the best predictive model for both clinical 
      outcomes. Paired biomarker models were not superior to those including MR-proADM 
      as the sole circulating biomarker. CONCLUSION: MR-proADM most powerfully 
      portended worse prognosis and should be further assessed as possibly the 
      biomarker of choice for risk stratification in AS.
CI  - (c) Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Tan, Eugene S J
AU  - Tan ESJ
AUID- ORCID: 0000-0001-7273-6883
AD  - Department of Cardiology, National University Heart Centre, Singapore.
AD  - Yong Loo Lin School of Medicine, National University Singapore, Singapore.
FAU - Oon, Yen Yee
AU  - Oon YY
AD  - Department of Cardiology, National University Heart Centre, Singapore.
AD  - Department of Cardiology, Sarawak Heart Center, Sarawak, Malaysia.
FAU - Chan, Siew Pang
AU  - Chan SP
AD  - Yong Loo Lin School of Medicine, National University Singapore, Singapore.
FAU - Liew, Oi Wah
AU  - Liew OW
AD  - Yong Loo Lin School of Medicine, National University Singapore, Singapore.
AD  - Cardiovascular Research Institute, National University Heart Centre, Singapore.
FAU - Chong, Jenny P C
AU  - Chong JPC
AD  - Yong Loo Lin School of Medicine, National University Singapore, Singapore.
AD  - Cardiovascular Research Institute, National University Heart Centre, Singapore.
FAU - Tay, Edgar
AU  - Tay E
AD  - Department of Cardiology, National University Heart Centre, Singapore.
AD  - Asian Heart & Vascular Centre, Mount Elizabeth Novena Hospital, Singapore.
FAU - Soo, Wern Miin
AU  - Soo WM
AD  - Department of Cardiology, National University Heart Centre, Singapore.
FAU - Yip, James W L
AU  - Yip JWL
AD  - Department of Cardiology, National University Heart Centre, Singapore.
AD  - Yong Loo Lin School of Medicine, National University Singapore, Singapore.
FAU - Gong, Lingli
AU  - Gong L
AD  - Yong Loo Lin School of Medicine, National University Singapore, Singapore.
FAU - Lunaria, Josephine B
AU  - Lunaria JB
AD  - Yong Loo Lin School of Medicine, National University Singapore, Singapore.
FAU - Yong, Quek Wei
AU  - Yong QW
AD  - Department of Cardiology, Tan Tock Seng Hospital, Singapore.
FAU - Lee, Evelyn Min
AU  - Lee EM
AD  - Department of Cardiology, Tan Tock Seng Hospital, Singapore.
FAU - Yeo, Daniel P S
AU  - Yeo DPS
AD  - Department of Cardiology, Tan Tock Seng Hospital, Singapore.
AD  - Apex Heart Clinic, Gleneagles Hospital, Singapore.
FAU - Ding, Zee Pin
AU  - Ding ZP
AD  - Department of Cardiology, National Heart Centre, Singapore.
FAU - Tang, Hak Chiaw
AU  - Tang HC
AD  - Department of Cardiology, National Heart Centre, Singapore.
FAU - Ewe, See Hooi
AU  - Ewe SH
AD  - Department of Cardiology, National Heart Centre, Singapore.
FAU - Chin, Calvin C W
AU  - Chin CCW
AD  - Department of Cardiology, National Heart Centre, Singapore.
FAU - Chai, Siang Chew
AU  - Chai SC
AD  - Department of Cardiology, Changi General Hospital, Singapore.
FAU - Goh, Ping Ping
AU  - Goh PP
AD  - Asian Heart & Vascular Centre, Mount Elizabeth Novena Hospital, Singapore.
FAU - Ling, Lee Fong
AU  - Ling LF
AD  - Department of Cardiology, Khoo Teck Puat Hospital, Singapore.
FAU - Ong, Hean Yee
AU  - Ong HY
AD  - Department of Cardiology, Khoo Teck Puat Hospital, Singapore.
FAU - Richards, A Mark
AU  - Richards AM
AD  - Department of Cardiology, National University Heart Centre, Singapore.
AD  - Yong Loo Lin School of Medicine, National University Singapore, Singapore.
AD  - Cardiovascular Research Institute, National University Heart Centre, Singapore.
AD  - Christchurch Heart Institute, University of Otago, Dunedin, New Zealand.
FAU - Ling, Lieng Hsi
AU  - Ling LH
AUID- ORCID: 0000-0001-6063-8530
AD  - Department of Cardiology, National University Heart Centre, Singapore 
      mdcllh@nus.edu.sg.
AD  - Yong Loo Lin School of Medicine, National University Singapore, Singapore.
AD  - Cardiovascular Research Institute, National University Heart Centre, Singapore.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220727
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Biomarkers)
RN  - 0 (Interleukin-1 Receptor-Like 1 Protein)
RN  - 0 (Peptide Fragments)
RN  - 0 (Protein Precursors)
RN  - 0 (proadrenomedullin)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 148498-78-6 (Adrenomedullin)
RN  - 85637-73-6 (Atrial Natriuretic Factor)
SB  - IM
CIN - Heart. 2022 Jul 27;108(16):1255-1256. PMID: 35613714
MH  - Adrenomedullin
MH  - Aged
MH  - Aged, 80 and over
MH  - *Aortic Valve Stenosis/diagnosis
MH  - Atrial Natriuretic Factor
MH  - Biomarkers
MH  - Female
MH  - *Heart Failure
MH  - Humans
MH  - Interleukin-1 Receptor-Like 1 Protein
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain
MH  - Peptide Fragments
MH  - Prognosis
MH  - Protein Precursors
MH  - Stroke Volume
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - Aortic stenosis
OT  - Biomarkers
COIS- Competing interests: SHE reports personal fees from Medtronic, Edwards 
      Lifesciences and Abbott Medical, outside the submitted work. ZPD reports 
      personal/speaker fees from GE and Phillips, and non-financial support from 
      Phillips, outside the submitted work. AMR reports grants from National Medical 
      Research Council of Singapore during the conduct of the study, is a long-term 
      collaborator with Roche Diagnostics, the provider of assays central to this 
      submission, and received support in kind, grants, speaker's honoraria and acted 
      on advisory boards for Roche Diagnostics. LHHL reports grants from National 
      Medical Research Council of Singapore during the conduct of the study.
EDAT- 2022/03/26 06:00
MHDA- 2022/07/30 06:00
CRDT- 2022/03/25 05:35
PHST- 2021/12/14 00:00 [received]
PHST- 2022/03/07 00:00 [accepted]
PHST- 2022/03/26 06:00 [pubmed]
PHST- 2022/07/30 06:00 [medline]
PHST- 2022/03/25 05:35 [entrez]
AID - heartjnl-2021-320707 [pii]
AID - 10.1136/heartjnl-2021-320707 [doi]
PST - epublish
SO  - Heart. 2022 Jul 27;108(16):1319-1327. doi: 10.1136/heartjnl-2021-320707.