Bioactive adrenomedullin (bio-ADM) is associated with endothelial dysfunction in infants and children with complex congenital heart disease undergoing open-heart surgery on cardiopulmonary bypass.

Schaefer, Maike; Stein, Andreas; Ruf, Bettina; Balling, Gunter; Palm, Jonas; Simmelbauer, Andreas; Cleuziou, Julie; Sander, Michaela; Auer, Josef; Borgmann, Kristina; Struck, Joachim; Hartmann, Oliver; Schulte, Janin; Hörer, Jürgen; Tassani-Prell, Peter; Ewert, Peter; Holdenrieder, Stefan; Wolf, Cordula M

doi:10.1515/cclm-2023-0511

2024

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Document type:: Journal Article
Author(s):: Schaefer, Maike; Stein, Andreas; Ruf, Bettina; Balling, Gunter; Palm, Jonas; Simmelbauer, Andreas; Cleuziou, Julie; Sander, Michaela; Auer, Josef; Borgmann, Kristina; Struck, Joachim; Hartmann, Oliver; Schulte, Janin; Hörer, Jürgen; Tassani-Prell, Peter; Ewert, Peter; Holdenrieder, Stefan; Wolf, Cordula M
Title:: Bioactive adrenomedullin (bio-ADM) is associated with endothelial dysfunction in infants and children with complex congenital heart disease undergoing open-heart surgery on cardiopulmonary bypass.
Abstract:: OBJECTIVES: Children with congenital heart disease (CHD) undergoing cardiac surgery on cardiopulmonary bypass (CPB) are at risk for systemic inflammation leading to endothelial dysfunction associated with increased morbidity. Bioactive adrenomedullin (bio-ADM) is a peptide regulating vascular tone and endothelial permeability. The aim of this study was to evaluate the dynamics of plasma bio-ADM in this patient cohort and its role in capillary leak. METHODS: Plasma samples from 73 pediatric CHD patients were collected for bio-ADM measurement at five different timepoints (TP) in the pre-, intra-, and post-operative period. The primary endpoint was a net increase in bio-ADM levels after surgery on CPB. Secondary endpoints included association of bio-ADM levels with clinical signs for endothelial dysfunction. RESULTS: Bio-ADM levels increased after surgery on CPB from pre-operative median of 12 pg/mL (IQR [interquartile range] 12.0-14.8 pg/mL) to a maximum post-operative median of 48.8 pg/mL (IQR 34.5-69.6 pg/mL, p<0.001). Bio-ADM concentrations correlated positively with post-operative volume balance, (r=0.341; p=0.005), increased demand for vasoactive medication (duration: r=0.415; p<0.001; quantity: TP3: r=0.415, p<0.001; TP4: r=0.414, p<0.001), and hydrocortisone treatment for vasoplegia (bio-ADM median [IQR]:129.1 [55.4-139.2] pg/mL vs. 37.9 [25.2-64.6] pg/mL; p=0.034). Patients who required pleural effusion drainage revealed higher bio-ADM levels compared to those who did not (median [IQR]: 66.4 [55.4-90.9] pg/mL vs. 40.2 [28.2-57.0] pg/mL; p<0.001). CONCLUSIONS: Bio-ADM is elevated in children after cardiac surgery and higher levels correlate with clinical signs of capillary leakage. The peptide should be considered as biomarker for endothelial dysfunction and as potential therapeutic target in this indication.
Journal title abbreviation:: Clin Chem Lab Med
Year:: 2024
Journal volume:: 62
Journal issue:: 3
Pages contribution:: 551-561
Fulltext / DOI:: doi:10.1515/cclm-2023-0511
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/37870269
Print-ISSN:: 1434-6621
TUM Institution:: Klinik für Chirurgie angeborener Herzfehler und Kinderherzchirurgie (DHM) (Prof. Hörer)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Chirurgie angeborener Herzfehler und Kinderherzchirurgie (DHM) (Prof. Hörer)2024