Midregion prohormone adrenomedullin (MR-proADM) – a prognostic marker in acute dyspnea

Midregion prohormone adrenomedullin (MR-proADM) – a prognostic marker in acute dyspnea

Midregion prohormone adrenomedullin (MR-proADM): Adrenomedullin (ADM) is a vasodilatory peptide with potent hypotensive effects. Plasma levels of adrenomedullin are increased in chronic heart failure and levels increase with severity of heart failure. But biological instability makes clinically useful measurements difficult. A stable midregion prohormone (MR-proADM) is being evaluated for clinical utility. In the BACH study (Biomarkers in Acute Heart Failure), it was compared with B-type natriuretic peptide (BNP) [Maisel A et al. Mid-region pro-hormone markers for diagnosis and prognosis in acute dyspnea: results from the BACH (Biomarkers in Acute Heart Failure) trial J Am Coll Cardiol 2010;55:2062-2076]. The BACH study concluded that MR-proANP is as useful as BNP for the diagnosis of acute heart failure and identifies patients with a high three month mortality risk. It was found to add on to the prognostic value of BNP and thought to provide additional use in those in whom there were difficulties in interpreting BNP values like those with intermediate BNP values, in those with obesity, in the elderly and in patients with edema. A recent report confirmed the use of midregion proadrenomedullin (MR-proADM) in all patients presenting with acute dyspnea both of cardiac and noncardiac origin [Maisel A et al. Midregion Prohormone Adrenomedullin and Prognosis in Patients Presenting With Acute Dyspnea Results From the BACH (Biomarkers in Acute Heart Failure) Trial. J Am Coll Cardiol, 2011; 58:1057-1067].