A comparative study on the roles of adrenomedullin and brain natriuretic peptide in congestive heart failure

Objective To study the plasma levels of adrenomedullin(ADM)and brain natriuretic peptide(BNP)in patients with congestive heart failure(CHF),and compare the clinical value,sensitivity and specificity between the both as diagnostic approaches for CHF.Methods Seventy-two patients with CHF [mean age =(61±16)yrs] were recruited as the study group,comprising 20 cases of survived myocardial infarction or ischemic cardiomyopathy,16 of hypertension,18 of valvular incompetence predominant rheumatic heart disease(RHD),and 18 of dilated cardiomyopathy(DCM).According to functional classification of New York Heart Association(NYHA),these patients included 20 with grade 2 cardiac function,22 with grade 3 and 30 with grade 4 cardiac function.Based on ejection fraction(EF),40 patients had an EF 40% and 32 had an EF ≥40%.Another 45 non-CHF patients were recruited as controls [mean age =(62±6)yrs],comprising 24 cases of angina pectoris and 21 of hypertension.Of blood samples,plasma ADM levels were determined by radioimmunoassay,and BNP levels were measured with ELISA.All patients received color Doppler echocardiography to determine left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVED).Results Overall,BNP levels in CHF group were markedly higher than those in non-CHF subjects(P0.05).ADM levels seemed to be higher in CHF patients,but the difference was of no statistical significance.BNP and ADM levels had significantly negative correlations with LVEF(P0.05).BNP levels were independent of etiologies,and demonstrated accurate for diagnosis of CHF with an area under curve(AUC)of receiver operating characteristics(ROC)of 0.82,showing advantages in sensitivity and specificity as compared with ADM(P0.01).In relation to NYHA cardiac function grading,levels of ADM and BNP were higher in grade 3 than in grade 2(both P0.05).While ADM(P0.05)and BNP(P0.05)appeared to be higher in grade 4 than in grade 2,the both tended to be lower in grade 4 compared with grade 3.Conclusion ADM and BNP levels showed benefits in the diagnosis of varied heart functional grading.The sensitivity and specificity of BNP were better than those of ADM.