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The midregional portion of proadrenomedullin is an independent predictor of left ventricular mass index in hypertension

By S. S. Bhandari, J. E. Davies, J. Struck and L. L. Ng

Abstract

Metadata. \ud Full text of this item is not currently available on the LRA.Left ventricular hypertrophy (LVH) is a risk factor for cardiovascular disease. Elevated natriuretic peptides in LVH have spurred interest that biomarkers may play a role in screening programs. Adrenomedullin (ADM) is a 52-amino acid peptide mediating vasorelaxation, natriuresis, and diuresis. The midregional portion of proADM (MRproADM) is secreted stoichiometrically with ADM; hence, it can be used as a surrogate marker of ADM. We compared the diagnostic performance of MRproADM for the detection of LVH with N-terminal pro-Btype natriuretic peptide (NTproBNP). Two hundred fifty-three hypertensive patients were derived from a local screening study. The MRproADM and NTproBNP levels were assayed using immunoluminometric assays. The MRproADM levels were significantly elevated in patients with LVH than those without (mean [SD]: 0.73 [0.25] vs 0.59 [0.18] nmol/L, P b .001). In multivariate analyses, male sex (P b .001) and log MRproADM (P = .003) retained significance for detecting LVH. Receiver operating characteristic curve for MRproADM yielded an area under the curve of 0.71; confidence interval, 0.62-0.81; P b .001, superior to NTproBNP. An optimal cutoff value for RproADM as an indicator of LVH was 0.50 nmol/L, with a sensitivity, specificity, and negative redictive value of 90.5%, 36.5%, and 95.1%, respectively. The high negative predictive value of the MRproADM assay allows it to be used as a rule-out test for LVH when stratifying patients into high or low risk. Patients who test positive would necessitate echocardiography, enabling better resource allocation

Publisher: Elsevier
Year: 2010
DOI identifier: 10.1016/j.metabol.2009.06.019
OAI identifier: oai:lra.le.ac.uk:2381/7852
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