Objective. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide (NO) synthesis, is reported to be a risk factor for cardiovascular disease. The purpose of the present study is to investigate whether ADMA is an independent predictor for future mortality and adverse clinical events among patients with heart failure (HF). Methods. Electronic literature databases (Central, MEDLINE, and Embase) were searched for relevant observational studies on the prognostic value of ADMA in HF patients published before January 2019. Pooled hazard ratios (HRs) or odds ratio and the corresponding 95% confidence interval (CI) were calculated for risk evaluation. Results. 10 studies with 2195 participants were identified and analyzed. The pooled HR of composite clinical events for the highest vs. lowest quartiles from categorical variable results was 1.34 (95% CI: 1.15-1.57, , %), which is 1.31 (95% CI: 1.10-1.55, , %) in the subgroup of acute decompensated HF. The pooled HR of composite clinical events from continuous variable results was 1.41 (95% CI: 1.21-1.63, , %), with 0.1 μM increment accounting for the increasing 25% risk for composite adverse clinical events. The pooled HR for all-cause mortality was 2.38 (95% CI: 1.48-3.82, , %) after sensitivity analysis. Two studies reporting the HR of inhospital mortality in HF patients regarded it as a prognostic indicator, with categorical variable HR as 1.26 (95% CI: 1.07-1.84, ) and continuous variable OR as 2.15 (95% CI: 1.17–4.29, ). Conclusions. ADMA is an independent predictor for composite clinical outcomes among HF patients with both short-term and long-term prognostic value.

中文翻译：

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不对称二甲基精氨酸对心力衰竭患者的预后价值：系统评价和荟萃分析。

客观。据报道，不对称二甲基精氨酸 (ADMA) 是一氧化氮 (NO) 合成的内源性抑制剂，是心血管疾病的危险因素。本研究的目的是调查 ADMA 是否是心力衰竭 (HF) 患者未来死亡率和不良临床事件的独立预测因子。方法。在电子文献数据库（Central、MEDLINE 和 Embase）中搜索了 2019 年 1 月之前发表的关于 ADMA 对 HF 患者预后价值的相关观察性研究。汇总风险比 (HRs) 或优势比以及相应的 95% 置信区间 (CI)计算用于风险评估。结果. 确定并分析了 10 项涉及 2195 名参与者的研究。分类变量结果中最高与最低四分位数的复合临床事件的汇总 HR 为 1.34（95% CI：1.15-1.57，, %), 即 1.31 (95% CI: 1.10-1.55,, %) 在急性失代偿 HF 亚组中。来自连续变量结果的复合临床事件的汇总 HR 为 1.41（95% CI：1.21-1.63，, %），以 0.1  μM增量说明复合不良临床事件的风险增加 25%。全因死亡率的汇总 HR 为 2.38（95% CI：1.48-3.82，, %) 敏感性分析后。两项报告 HF 患者住院死亡率 HR 的研究将其视为预后指标，分类变量 HR 为 1.26 (95% CI: 1.07-1.84,)和连续变量 OR 为 2.15 (95% CI: 1.17–4.29,）。 结论。ADMA 是 HF 患者综合临床结果的独立预测因子，具有短期和长期预后价值。