Midregional proadrenomedullin (MR-proADM) is a powerful predictor of early death in AL amyloidosis

Abstract

Background: Cardiac biomarkers play a major role in the identification of patients at risk of early death in AL amyloidosis, and a staging system based on amino-terminal pro-natriuretic peptide type-B (NT-proBNP) and troponins (cTn) is used for prognostic stratification. Adrenomedullin is produced by several tissues including the heart, and portends a poor prognosis in heart diseases. We investigated the ability of midregional proadrenomedullin (MR-proADM) to predict early death in AL amyloidosis. Methods: One-hundred and thirty consecutive patients with newly-diagnosed AL amyloidosis were prospectively enrolled. The impact on survival of NT-proBNP, cTnI and MR-proADM was evaluated. Results: The concentration of MR-proADM correlated with systolic and diastolic function, but did not reflect the amount of amyloid deposited in the heart. Moreover, MR-proADM was associated with non-cardiac markers of advanced disease. The staging system based on NT-proBNP and cTnI identified high-risk subjects, but could not discriminate good-risk and intermediate-risk patients. Conversely, a staging system based on MR-proADM and cTnI identified 3 groups with significantly different survivals. Conclusions: Midregional-proADM is a powerful prognostic marker in AL amyloidosis, which may not only reflect cardiac dysfunction but also widespread systemic disease, and can be combined with cTn for detecting patients at risk of early death.

Keywords::

• heart
• troponin
• B-type natriuretic peptide
• staging
• prognosis
• survival

Acknowledgments

The Authors are grateful to Dr. Leda Roggeri for data management and thank B.R.A.H.M.S. Biomarkers for providing the reagents for measuring midregionalproadrenomedullin.

Declaration of interest: The authors have no conflict of interest to disclose. This work was supported by grants from the, Ministry of Health (Ricerca Finalizzata Malattie Rare), “Istituto Superiore di Sanità” (526D/63); Ministry of Research and University (2007AESFX2_003); and “Associazione Italiana per la Ricerca sul Cancro” Program “Harnessing tumor cell/microenvironment cross talk to treat mature B cell tumors”.