• Justas Simonavičius, Aurimas Mikalauskas, Kamilė Čerlinskaitė, Etienne Gayat, Vytautas Juknevičius, Eglė Palevičiūtė, Irina Alitoit-Marrote, Denis Kablučko, Loreta Bagdonaitė, Mindaugas Balčiūnas, Dovilė Vaičiulienė, Ieva Jonauskienė, Justina Motiejūnaitė, Kęstutis Stašaitis, Audrys Kukulskis, Šarūnas Damalakas, Toma Šimbelytė, Neringa Taparauskaitė, Gintarė Pukanasienė, Aleksandras Laucevičius, Aušra Kavoliūnienė, Alexandre Mebazaa, Jelena Čelutkienė, and GREAT network.
• Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Maastricht University Medical Centre, Maastricht, the Netherlands. Electronic address: j.simonavicius@gmail.com.
• Am. J. Med. 2022 Jul 1; 135 (7): e165-e181.

PurposeThis study was designed to evaluate the role of biologically active adrenomedullin (bio-ADM) in congestion assessment and risk stratification in acute dyspnea.MethodsThis is a sub-analysis of the Lithuanian Echocardiography Study of Dyspnea in Acute Settings. Congestion was assessed by means of clinical (peripheral edema, rales) and sonographic (estimated right atrial pressure) parameters. Ninety-day mortality was chosen for outcome analysis.ResultsThere were 1188 patients included. Bio-ADM concentration was higher in patients with peripheral edema at admission (48.2 [28.2-92.6] vs 35.4 [20.9-59.2] ng/L, P < .001). There was a stepwise increase in bio-ADM concentration with increasing prevalence of rales: 29.8 [18.8-51.1], 38.5 [27.5-67.1], and 51.1 [33.1-103.2] ng/L in patients with no rales, rales covering less than one-half, and greater than or equal to one-half of the pulmonary area, respectively (P < 0.001). Bio-ADM concentration demonstrated gradual elevation in patients with normal, moderately, and severely increased estimated right atrial pressure: 25.1 [17.6-42.4] ng/L, 36.1 [23.1-50.2], and 47.1 [30.7-86.7] ng/L, respectively (P < .05). Patients with bio-ADM concentration >35.5 ng/L were at more than twofold increased risk of dying (P < .001). Survival in those with high bio-ADM was significantly modified by neurohormonal blockade at admission (P < .05), especially if NT-proBNP levels were lower than the median (P = .002 for interaction).ConclusionBio-ADM reflects the presence and the degree of pulmonary, peripheral, and intravascular volume overload and is strongly related to 90-day mortality in acute dyspnea. Patients with high bio-ADM levels demonstrated survival benefit from neurohormonal blockade.Copyright © 2022 Elsevier Inc. All rights reserved.

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