Objective-The purpose of this study was to investigate whether elevated ADMA concentrations are associated with increased cardiovascular risk in chronic heart failure (HF) patients. Methods and Results-253 patients with symptomatic chronic HF and impaired left ventricular function (median age 70 years, 202 males) were followed for a median of 14.2 months (interquartile range 6.8 to 21.2). ADMA and N-terminal probrain natriuretic peptide (NT-proBNP) were assessed by high performance liquid

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... tography and by an enzyme-linked immunosorbent assay, respectively. Subjects with ADMA concentrations in the highest tertile had a significantly higher adjusted hazard ratio (HR; 2.00; 95% confidence interval [CI] 1.01 to 3.97) for occurrence of an end point (cardiac decompensation, major adverse cardiovascular events or all-cause mortality) compared with patients in the lowest tertile (Pϭ0.046) during the first 6 months of follow-up. NT-proBNP also identified subjects at risk before adjustment for confounders at 6 and 12 months of follow-up. HR for patients with ADMA and NT-proBNP in the highest tertile was significantly increased (3.68, CI 1.67 to 8.14; at 6 months follow-up) compared with patients without ADMA and NT-proBNP in the highest tertile (PϽ0.001). Conclusions-Elevated ADMA plasma concentrations are associated with adverse cardiovascular outcome in patients with chronic HF. Quantification of ADMA with NT-proBNP improves risk stratification in this cohort. (Arterioscler Thromb Vasc Biol. 2007;27:000-000.) all consecutive patients with diagnosis of chronic HF and reduced left ventricular function, who were admitted at the ward or referred to the outpatient HF clinic at the tertiary care hospital of the Salzburger Landeskliniken/Paracelsus Medical University, were invited to participate in a prospective cohort study. Inclusion criteria were written informed consent, left ventricular ejection fraction (EF) of Յ40%, age Ն18 years, and a scheduled visit for follow-up at the HF clinic. Exclusion criteria were acute cardiac decompensation within the previous 7 days, need for coronary revascularization, or acute coronary syndrome. The study protocol was approved by the independent Ethics Committee of the Medical University of Vienna (EC# 541/2004).