Asymmetrical dimethylarginine--more sensitive than NT-proBNP to diagnose heart failure in adults with congenital heart disease

PLoS One. 2012;7(3):e33795. doi: 10.1371/journal.pone.0033795. Epub 2012 Mar 21.


Background: Chronic heart failure is an important cause for morbidity and mortality in adults with congenital heart disease (ACHD). While NT-proBNP is an established biomarker for heart failure of non-congenital origin, its value in ACHD has limitations. Asymmetrical dimethylarginine (ADMA) correlates with disease severity and independently predicts adverse clinical events in heart failure of non-congenital origin. Its role in ACHD has not been investigated.

Methods: In 102 patients ADMA and NT-proBNP were measured and related to NYHA class, systemic ventricular function and parameters of cardiopulmonary exercise testing.

Results: In contrast to NT-proBNP ADMA differentiated between NYHA classes I-III. Both, ADMA and NT-proBNP showed a good correlation with parameters of cardiopulmonary exercise testing with comparable receiver-operating characteristic curves for identifying patients with severely limited cardiopulmonary exercise capacity.

Conclusion: ADMA seems to be a better biomarker than NT-proBNP for the assessment of NYHA class and as a good as NT-proBNP for the estimation of maximum exercise capacity in adults with congenital heart disease. Its use in clinical routine should be evaluated.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Arginine / analogs & derivatives*
  • Arginine / blood
  • Biomarkers / blood
  • Cross-Sectional Studies
  • Echocardiography
  • Exercise Test
  • Female
  • Heart Defects, Congenital / complications*
  • Heart Failure / complications*
  • Heart Failure / diagnosis*
  • Heart Failure / mortality
  • Humans
  • Male
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • ROC Curve
  • Ventricular Dysfunction, Left
  • Young Adult


  • Biomarkers
  • Peptide Fragments
  • dimethylarginine
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Arginine