{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T18:53:51Z","timestamp":1792263231921,"version":"4.4.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>With the increasing diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) at earlier stages and new therapies, there is a rising demand for tools to stratify risk and prognosis. We evaluated the prognostic value of multiple circulating biomarkers for predicting outcomes in ATTR-CM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We evaluated 12 different circulating biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin I [hsTnI], mid-regional pro-adrenomedullin [MR-proADM], carbohydrate antigen 125 [CA125], soluble suppression of tumorigenicity 2 [sST2], cluster of differentiation antigen 146 [CD146], growth\/differentiation factor-15 [GDF-15], alpha-klotho, fibroblast growth factor 23 [FGF-23], galectin-3, insulin-like growth factor-binding protein 7 [IGFBP-7], and estimated glomerular filtration rate [eGFR]) in 337 ATTR-CM patients from Spain. Cox models were employed to determine their predictive abilities. Findings were validated in 2 independent external cohorts of 210 patients from the United States and 416 patients from the ATTR-ACT trial, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Over a median follow-up of 19.7 months (IQR, 6.5\u201342.3), 67 patients (19.9%) died\/underwent heart transplantation, and 81 (24%) had heart failure events. MR-proADM was the biomarker with the strongest prognostic performance, with a C-index of 0.788 (95% CI, 0.723\u20130.851) for all-cause mortality and 0.721 (95% CI, 0.669\u20130.772) for the composite end point of death and heart failure events. MR-proADM was associated with multiple parameters of ATTR-CM severity and was independently associated with mortality, heart failure events, and the composite end point. MR-proADM \u22651.1 nmol\/L was identified as the optimal prognostic threshold, and it improved prediction of mortality when added to the National Amyloid Center (area under the curve [AUC], 0.682 versus 0.737;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), Mayo (AUC, 0.659 versus 0.749;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), and the Columbia staging systems (AUC, 0.699 versus 0.768;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). In both validation cohorts, patients with MR-proADM \u22651.1 nmol\/L had worse outcomes (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). This association was also confirmed in patients receiving tafamidis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In patients with ATTR-CM, MR-proADM levels are associated with disease severity and worse prognosis. MR-proADM improves prediction of all-cause mortality and captures heart failure events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.125.077833","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T09:00:19Z","timestamp":1774947619000},"page":"1350-1361","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["MR-proADM Predicts Mortality and Heart Failure Events in ATTR Cardiac Amyloidosis"],"prefix":"10.1161","volume":"153","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9081-7003","authenticated-orcid":true,"given":"Bel\u00e9n","family":"Peir\u00f3-Avent\u00edn","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Majadahonda, Spain (B.P.-A., M.B., E.G.-L., F.D., P.G.-P.)."},{"name":"Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (B.P.-A., M.A.F.-R., R.M.C., F.D., P.G.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8962-5936","authenticated-orcid":true,"given":"Elena","family":"Revuelta-Lopez","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain (E.R.-L., A.C., M.R.-C., J.L., A.B.-G.)."},{"name":"CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.R.-L., J.N., E.G.-L., F.D., M.R.-C., J.L., A.B.-G., P.G.-P.)."},{"name":"ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain (E.R.-L., B.M., A.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9913-0435","authenticated-orcid":true,"given":"Mariana","family":"Brand\u00e3o","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Majadahonda, Spain (B.P.-A., M.B., E.G.-L., F.D., P.G.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1672-7119","authenticated-orcid":true,"given":"Julio","family":"Nu\u00f1ez","sequence":"additional","affiliation":[{"name":"CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.R.-L., J.N., E.G.-L., F.D., M.R.-C., J.L., A.B.-G., P.G.-P.)."},{"name":"Cardiology Department, Hospital Cl\u00ednico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain (J.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2240-1951","authenticated-orcid":true,"given":"Manuel A.","family":"Fern\u00e1ndez-Rojo","sequence":"additional","affiliation":[{"name":"Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (B.P.-A., M.A.F.-R., R.M.C., F.D., P.G.-P.)."},{"name":"The University of Queensland, Frazer Institute, Brisbane, Australia (M.A.F.-R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa M.","family":"Carmona","sequence":"additional","affiliation":[{"name":"Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (B.P.-A., M.A.F.-R., R.M.C., F.D., P.G.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4837-5109","authenticated-orcid":true,"given":"Borja","family":"Montejo","sequence":"additional","affiliation":[{"name":"ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain (E.R.-L., B.M., A.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Ferrando-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain (A.F.-M., A.M.-G., 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