The L-Arginine-Asymmetric Dimethylarginine Ratio is an Independent Predictor of Mortality in Dilated Cardiomyopathy
The L-Arginine-Asymmetric Dimethylarginine Ratio is an Independent Predictor of Mortality in Dilated Cardiomyopathy
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DOI：
10.1016/j.cardfail.2012.10.011
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发表时间：
2012-12-01
影响因子：
6
通讯作者：
Boeger, Rainer H.
中科院分区：
文献类型：
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作者：
Anderssohn, Maike;Rosenberg, Mark;Boeger, Rainer H.
背景：不对称二甲基精氨酸（ADMA）与慢性心力衰竭患者死亡率增加有关，但心力衰竭的病因是否影响二甲基精氨酸的预后价值尚不清楚。方法与结果：采用液相色谱-串联质谱法测定341例扩张型心肌病（DCM， 226例）或缺血性心肌病（ICM， 115例）慢性心力衰竭患者的l -精氨酸、ADMA和对称二甲基精氨酸（SDMA）含量。重度心衰患者（纽约心脏协会（NYHA）功能等级III或IV）与轻度心衰患者（NYHA功能等级I或II）相比，血浆ADMA和SDMA水平中位数（四分位数范围[IQR]）较高，L-精氨酸和L-精氨酸ADMA比值较低(ADMA 0.57 (0.14) 1 mu mol/L vs 0.54 (0.12) mu mol/L [P < 0.001]；SDMA为0.47 (0.27)μ mol/L vs 0.37 (0.13) μ mol/L [P < 0.001]；L-精氨酸分别为81.8 (39.1)mu mol/L和92.6 (39.3)mu mol/L [P < 0.01])，但不同病因间差异无统计学意义。l -精氨酸ADMA比值仅与DCM患者的预后相关。在多因素分析中，在3.3年的中位观察时间内，最高四分位数的DCM患者的死亡风险显著低于最低四分位数的患者（风险比0.31,95% CI 0.11-0.88; P = 0.028，经其他危险因素校正）。结论：l -精氨酸ADMA比不良的DCM患者死亡风险增加。（journal of heart failure, 2012, 18:904-911）
Background: Asymmetric dimethylarginine (ADMA) is associated with increased mortality in patients with chronic heart failure but it remains unclear if the etiology of heart failure influences the prognostic value of dimethylarginines.Methods and Results: L-Arginine, ADMA, and symmetric dimethylarginine (SDMA) were measured by liquid chromatography-tandem mass spectrometry in 341 patients with chronic heart failure due to dilated cardiomyopathy (DCM; n = 226) or ischemic cardiomyopathy (ICM; n = 115). Median (interquartile range [IQR]) ADMA and SDMA plasma levels were higher, L-arginine and the L-arginine ADMA ratio were lower in patients with severe forms of heart failure (New York Heart Association (NYHA) functional class III or IV) compared with milder forms (NYHA functional class I or II) (ADMA 0.57 (0.14) 1 mu mol/L vs 0.54 (0.12) mu mol/L [P < .001]; SDMA 0.47 (0.27)] mu mol/L vs 0.37 (0.13) mu mol/L [P < .001]; L-arginine 81.8 (39.1) mu mol/L vs 92.6 (39.3) mu mol/L [P < .01]), but no significant differences were observed between the different etiologies. The L-arginine ADMA ratio was associated with outcome only in patients with DCM. In multivariate analysis, the mortality risk of DCM patients was significantly lower for those in the highest quartile compared with the lowest quartile during a median observation time of 3.3 years (hazard ratio 0.31, 95% CI 0.11-0.88; P = .028, adjusted for other risk factors).Conclusions: DCM patients with unfavourable L-arginine ADMA ratio are at increased risk for death. (J Cardiac Fail 2012:18:904-911)