New Orleans—Mid-regional pro-adrenomedullin (MR-proADM) is a better biomarker for predicting short-term mortality in patients presenting with shortness of breath who are diagnosed with heart failure, according to results of the Biomarkers in the Assessment of Congestive Heart Failure (BACH) trial. Use of this marker was significantly more accurate than brain natriuretic peptide (BNP) or N-terminal prohormone BNP (NT-proBNP) in detecting which heart failure patients were likely to die.

MR-proADM is a vasodilator important for microcirculation and endothelial function.

“A marker that reflects the vascular status of the whole body, including the heart is a better prognosticator of mortality in these patients,” said Stefan D. Anker, MD (pictured) Virchow Hospital, Berlin, Germany.

BACH included 568 patients who presented to emergency rooms with shortness of breath not due to trauma or obvious myocardial infarction. Mean age was 64; 52 percent were female, 36 percent had a history of heart failure, 19 percent had a prior MI, 29 percent were diabetic, and the mean body mass index was 29 kg/m². The patients were assessed for heart failure, their biomarkers were measured, and they were followed for 90 days. The primary endpoint was whether MR-proADM level successfully predicted mortality.

Dr. Anker reports that MR-proADM had a prognostic accuracy of 73.5 percent compared with accuracy rates of 60.8 percent and 63.6 percent for BNP and NT-proBNP, respectively (P<0.001). “While measuring MR-proADM adds significantly to the utility of BNP or NT-proBNP, neither BNP nor NT-proBNP adds to the prognostic accuracy of using MR-proADM,” emphasizes Dr. Anker.

Researchers also compared MR-proADM to troponin values, which were available for 20.9 percent of the patients. They conclude that MR-proADM provides independent prognostic utility when used with troponin values while BNP and NT-proBNP do not (P<0.001).

In these heart failure patients, those with MR-proADM levels in the highest quartile (2.07 pmol/L or greater) had the greatest risk of death within 90 days (P<0.001). Furthermore, Dr. Anker says that MR-proADM level was even more accurate for predicting mortality during the first 30 days after measurement.

MR-proADM can significantly improve risk stratification over BNP or NT-proBNP and using this marker for assessment can help to identify patients who should move to the “front of the line” of medical care. “I think this can help triage patients. Resources are limited and medical education is not perfect everywhere,” Dr. Anker comments.