Heart failure & cardiomyopathies
MR-proADM Predicts Mortality and Heart Failure Events in ATTR Cardiac Amyloidosis
Authors' conclusion
In patients with ATTR-CM, MR-proADM levels are associated with disease severity and worse prognosis. MR-proADM improves prediction of all-cause mortality and captures heart failure events.
Study context
- Population
- Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) from Spainvalidation cohorts 210 and 416
- Participants
- 337 patients
- Comparison
- 12 circulating biomarkers for prediction of outcomes
- Outcome
- Prognostic performance of MR-proADM (strongest biomarker)
- Follow-up
- Median 19.7 months (IQR, 6.5-42.3)
Methodological detailsexternal validation in 2 independent cohorts
- External validation in 2 independent cohorts
Performance
As reported in the abstract
C-index for all-cause mortality
0.788
95% CI 0.723–0.851
C-index for composite of death and HF events
0.721
95% CI 0.669–0.772
Further findings
Events during follow-up · median follow-up 19.7 months
- Died/underwent heart transplantation
- 67 patients (19.9%)
- HF events
- 81 (24%)
Mortality prediction with MR-proADM ≥1.1 nmol/L added to staging systems (AUC without vs with)
- National Amyloid Center: AUC 0.682 vs 0.737
- P < 0.001
- Mayo: AUC 0.659 vs 0.749
- P < 0.001
- Columbia: AUC 0.699 vs 0.768
- P < 0.001
- MR-proADM ≥1.1 nmol/L optimal prognostic threshold
Outcomes with MR-proADM ≥1.1 nmol/L in validation cohorts
- Worse outcomes in both validation cohorts
- P < 0.001
- Association also confirmed in patients receiving tafamidis
Original publication
MR-proADM Predicts Mortality and Heart Failure Events in ATTR Cardiac Amyloidosis. Circulation. Published 31 March 2026. doi:10.
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