Bio-ADM as a marker for congestion in patients hospitalised for acute HF

In the STRONG-AF study, biologically active adrenomedullin (bio-ADM) was associated with symptoms of congestion in patients hospitalised for acute heart failure (HF). Participants in the highest tertile of bio-ADM were at the most elevated risk for the primary endpoint of all‐cause mortality or HF hospitalisation.

Better imaging techniques and biomarkers are needed to assess congestion in HF. The protein bio-ADM has a prominent role in maintaining a barrier function of the vascular endothelium and is a promising marker for residual congestion. Mr Geert Voordes (University Medical Center Groningen, the Netherlands) and colleagues evaluated bio-ADM as a marker for residual congestion and early re-hospitalisation in patients with acute HF [1].

Bio-ADM and NT-proBNP were measured in 1,005 baseline samples collected for the STRONG-HF trial. Participants were divided into tertiles (n=335 patients each) according to concentrations of both biomarkers: low bio-ADM (<13.32 pg/mL), medium bio-ADM (13.32–28.40 pg/mL), and high bio-ADM (>28.40 pg/mL); low NT-proBNP (<2,159 ng/L), medium NT-proBNP (2,160–4,165 ng/L), and high NT-proBNP (>4,165 ng/L).

Bio-ADM and NT-proBNP were linked to different signs and symptoms of HF. Elevated bio-ADM was associated primarily with oedema and orthopnoea, whereas elevated NT-proBNP was more associated with the presence of rales. There was no benefit of bio-ADM over NT-proBNP in predicting decongestion at day 90. There was no difference in bio-ADM levels at baseline and after 90 days (P=0.2689); however, there was a reduction in NT-proBNP levels between these time points. The prognostic value of bio-ADM was very limited (area under the curve 0.5963; 95% CI 0.5546–0.6380). The prognostic value of both markers combined was equally limited: area under the curve 0.6078 (95% CI 0.5666–0.6490). The tertile with the highest bio-ADM had the worst prognosis for HF hospitalisation (HR 2.33) and for all‐cause mortality or HF hospitalisation combined (HR 2.14). There was a modest trend towards significance (P=0.0588) for both markers combined (vs NT-proBNP alone) for the combined outcome of all‐cause mortality or HF hospitalisation. Baseline bio-ADM levels did not affect the treatment effect of high-intensity care.

1. 
   
   1. Voordes GHD, et al. Bio-ADM as a marker for residual congestion and early rehospitalization in patients hospitalized for acute heart failure; data from STRONG-HF. Late-breaking clinical trials II, Heart Failure 2024, 11–14 May, Lisbon, Portugal.

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Posted on 16 July 202416 July 2024