Biologically Active Adrenomedullin (bio-ADM) is of potential value in identifying congestion and selecting patients for neurohormonal blockade in acute dyspnea

PURPOSE: . This study was designed to evaluate the role of bio-ADM in congestion assessment and risk stratification in acute dyspnea. METHODS: . This is a sub-analysis of Lithuanian Echocardiography Study of Dyspnea in Acute Settings. Congestion was assessed by means of clinical (peripheral oedema, rales) and sonographic (estimated right atrial pressure [eRAP]) parameters. Ninety-day mortality was chosen for outcome analysis. RESULTS: . 1188 patients were included. Bio-ADM concentration was higher in patients with peripheral oedema at admission (48.2 [28.2-92.6] vs 35.4 [20.9-59.2] ng/L, p 35.5 ng/L were at more than two-fold increased risk of dying (p<0.001). Survival in those with high bio-ADM was significantly modified by neurohormonal blockade at admission (p<0.05), especially if NT-proBNP levels were lower than the median (p = 0.002 for interaction). CONCLUSION: . Bio-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