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Abstract
SUMMARY AND CONCLUSION
This study was carried out in Internal Medicine, Cardiology and Clinical Pathology Departments, Faculty of Medicine, Zagazig University Hospitals, during the period from October 2002 to November 2004.
This study has been carried out to measure the plasma concentration of adrenomedullin in patients with congestive heart failure due to various cardiac diseases and compare it to healthy subjects, the effect of two months treatment on those patients regarding adrenomedullin and the correlation between plasma adrenomedullin concentration and some echocardiographic parameters of those patients has been also studied.
For this purpose, fifty patients have been enrolled in this study, all with symptomatic CHF. The aetiologies of CHF were rheumatic heart disease 34%, hypertension heart disease 24%, ischaemic heart disease 14%, bilharzial cor-pulmonale 12%, hypoxic cor-pulmonale 8% and dilated cardiomyopathy 8% of the cases. Fifty percent of the cases have been suffering from mild symptoms (NYHA I-II), while the remaining fifty percent have been suffering from severe symptoms (NYHA III-IV). Ten healthy volunteers were taken as a control group.
All patients and control subjects who suffered one or more of the following were excluded from this study: history of myocardial infarction within six months, clinical evidence of unstable angina pectoris, acute infection, severe kidney or liver affection, autoimmune or inflammatory disease, diabetes mellitus and those receiving corticosteroids or immunosuppressive drug therapy. All subjects were subjected to complete clinical examination, resting ECG, chest x-ray P/A, echocardiography and the following laboratory investigations (liver function test, serum creatinine, erythrocytic sedimentation rate, random blood sugar, serum sodium and potassium and total plasma AM at time of inclusion and two months after treatment).
The following results have been found :
• There was a significant reduction of serum sodium level in group III patients (NYHA III-IV) compared to group II patients (NYHA I-II) and control group.
• There was a significant increase in creatinine level in group III patients compared to group II patients and control group.
• There was a significant increase in plasma adrenomedullin concentration in group II patients compared to control group, as well as increase in group III patients compared to control group, adrenomedullin tends to be significantly higher in group III patients than in group II patients.
• Plasma adrenomedullin concentration showed a significant reduction in response to two months medical treatment of heart failure.
• There was a significant positive correlation between AM and EDD, ESD and LAD in patient groups, however there was a significant inverse correlation between adrenomedullin and EF and FS%.
CONCLUSION :
From these results, it could be concluded that plasma adrenomedullin is elevating with increasing severity of heart failure and is related to (NYHA) functional class of patients with heart failure, making it not only an important biochemical marker for evaluating the severity of HF, but also a prognostic indicator of this syndrome, having a possible role in the defensive mechanisms against heart failure and raise the possibility of a new therapeutic approach against heart failure.
RECOMMENDATIONS :
It is recommended that further researches are needed on a large number of patients to clarify the exact mechanisms of adrenomedullin in heart failure with each etiology as well as to investigate the possibility of using adrenomedullin as a therapy against HF in humans and the possibility to invent oral preparation of this peptide together with the available intravenous form.