Heart failure & cardiomyopathies
Pro-Adrenomedullin as an Independent Predictive Biomarker for Heart Failure in Atrial Fibrillation and Flutter
Authors' conclusion
Pro-ADM is identified as an independent biomarker for predicting incident HF in AF and AFL patients. Its inclusion in risk prediction models enhances the ability to stratify HF risk beyond traditional biomarkers, demonstrating its potential utility in clinical practice.
Study context
- Population
- Patients with atrial fibrillation and flutter (AF and AFL)split into discovery and replication cohorts
- Participants
- 1,050 vs 305
- Comparison
- Plasma biomarkers screened for association with incident heart failure (HF)
- Discoveryn = 1,050
- Replicationn = 305
- Outcome
- Incident HF
- Follow-up
- Over a 14.2 years (discovery); over 13.8 years (replication)
Methodological detailsproteomic data from the UK Biobank Pharma Proteomics Project (UKB-PPP), multivariable-adjusted Cox proportional hazards model
- Proteomic data from the UK Biobank Pharma Proteomics Project (UKB-PPP)
- Multivariable-adjusted Cox proportional hazards model
Main finding
As reported in the abstract
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Incident HF per unit increase in pro-ADMEach unit increase in pro-ADM · discovery cohort; FDR = 0.026 | 2.78 (1.64–4.71) | P < 0.001 | |
| Incident HF per unit increase in pro-ADMEach unit increase in pro-ADM · replication cohort; FDR = 0.012 | 3.95 (1.97–7.94) | P < 0.001 | |
| Incident HF per unit increase in pro-ADM, sensitivity and subgroup analysesEach unit increase in pro-ADM · after excluding participants with self-reported AF and AFL · sensitivity analyses | 1.77 (1.02–3.04) | P = 0.041 | |
| Incident HF per unit increase in pro-ADM, sensitivity and subgroup analysesEach unit increase in pro-ADM · paroxysmal AF · sensitivity analyses | 2.80 (1.11–7.07) | P = 0.029 | |
| Incident HF per unit increase in pro-ADM, sensitivity and subgroup analysesEach unit increase in pro-ADM · persistent AF · sensitivity analyses | 4.36 (1.41–13.43) | P = 0.010 | |
| 0.050.21520Hazard ratio (log scale) |
Proteins associated with incident HF
- Out of 2923 proteins measured, only pro-adrenomedullin (pro-ADM) consistently showed a significant association with incident HF in both cohorts
Time to HF onset across pro-ADM quartiles
- Median times ranging from 2306 to 3183 days across quartiles
- P < 0.001
- Higher pro-ADM levels had significantly shorter time to HF onset
Cumulative incidence of HF across pro-ADM quartiles
- Ranged from 15.3% to 42.7% across quartiles of pro-ADM
- log-rank P < 0.001
Adding pro-ADM to a model with traditional risk factors, including NT-proBNP · 3-year
- AUC
- 0.783
- IDI
- 0.010
- NRI
- 0.206
- Both P = 0.002
Adding pro-ADM to a model with traditional risk factors, including NT-proBNP · 5-year
- AUC
- 0.749
- IDI
- 0.013
- NRI
- 0.179
- P = 0.001
Original publication
Pro-Adrenomedullin as an Independent Predictive Biomarker for Heart Failure in Atrial Fibrillation and Flutter. ESC Heart Fail. Published 13 January 2025. doi:10.
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