Midregion Prohormone Adrenomedullin and Prognosis in Patients Presenting With Acute Dyspnea: Results From the BACH (Biomarkers in Acute Heart Failure) Trial

Study Questions:

Do levels of midregion prohormone adrenomedullin (MR-proADM) predict prognosis in patients presenting with acute dyspnea?


The accuracy of MR-proADM for predicting 90-day mortality in patients (n = 1,641) presenting with acute dyspnea was evaluated. The prognostic accuracy was also compared to other biomarkers and clinical variables.


Compared with B-type natriuretic peptide (BNP) or troponin, MR-proADM was superior for predicting 90-day all-cause mortality (c index = 0.755, p < 0.0001). Furthermore, MR-proADM added significantly to all clinical variables (adjusted hazard ratio [HR], >3.28), and it was also superior to all other biomarkers. MR-proADM added significantly to the best clinical model (bootstrap-corrected c index increase, 0.775-0.807; adjusted standardized HR, 2.59; p < 0.0001). Serial evaluation of MR-proADM performed in patients admitted provided significant added value compared with a model with admission values only (p = 0.0005). More than one-third of patients originally at high risk could be identified by the biomarker evaluation at discharge as low-risk patients.


MR-proADM identifies patients with high 90-day mortality and adds prognostic value to natriuretic peptides in patients presenting with acute shortness of breath.


Plasma biomarkers such as BNP have proven useful in the diagnosis and management of patients presenting with dyspnea. Another vasodilatory peptide is ADM, which is produced by several tissues and has shown to be elevated in patients with congestive heart failure and other conditions. The clinical evaluation of ADM has been hampered due to its instability; thus, new assays have been designed to detect a relatively stable precursor fragment (MR-proADM). This study indicates that this marker adds important prognostic value to other clinical and plasma markers, especially when serial measurements are used. Further studies to validate whether this biomarker will be useful in guiding clinical management strategies are needed.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Prognosis, Biological Markers, Heart Failure, Dyspnea, Adrenomedullin, Troponin, Natriuretic Peptide, Brain

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