Author + information
- Yasin Türker1,
- Yusuf Aslantas1,
- Yasemin Türker2,
- Taner Ucgun3,
- Mehmet Akkaya4 and
- Melih Engin Erkan5
In some patients, including elderly, physically inactive or obese patients, it is difficult to assess the symptoms because of inactivity in patients with chronic mitral regurgitation. A noninvasive marker that shows early changes in the cardiovascular system would therefore be helpful in evaluating patients with MR. The aim of this study was to evaluate the association between plasma pro-adrenomedullin levels and MR and its prognostic value as indicator of cardiovascular prognosis in patients with moderate/severe MR.
A total of 221 consecutive patients (129 women [58.4%]; mean age 61.6±12.5 years) with isolated and organic moderate MR, moderate to severe MR or severe MR were included in the study. Patients were categorized according to the NYHA functional class. We assessed and graded the severity of MR using a multiparametric approach. Pro-adrenomedullin was measured with ELISA method. Patients were followed-up by outpatient assessments and telephone contact.
Baseline demographic and clinical characteristics of the study population are listed in Table 1. Echocardiographic and laboratory parameters of patients with mitral regurgitation and comparison between asymptomatic and symptomatic patients are listed Table 2. Pro-adrenomedullin was significantly higher among symptomatic MR patients when compared with asymptomatic patients (p<0.001). Median pro-adrenomedullin levels increased significantly with NYHA class (p<0.001, Figure 1) and with higher degrees of MR (p<0.001, Figure 2). Increased levels of serum creatinine, pro-adrenomedullin level, male gender, reduced LVEF, and higher NYHA functional classes were significantly associated with an increased risk of death during follow-up. In multivariate analysis, LVEF and NYHA class were the only independent predictors of death (Table 3).
Pro-adrenomedullin levels can help to identify patients with asymptomatic moderate/severe mitral regurgitation from the symptomatic ones. This may be useful in the optimal timing of mitral valve surgery in certain subset of patients.