Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Prognostic value of plasma endothelin-1 in patients with chronic heart failure
*Departments of Cardiology, Pitié-Salpêiriére Hospital, Institut Fédératif de Recherche Physiopathologique et Génétique Cardiovasculaire Paris, France
Departments of Pharmacology, Pitié-Salpêiriére Hospital, Institut Fédératif de Recherche Physiopathologique et Génétique Cardiovasculaire Paris, France
Departments of Biochemistry, Pitié-Salpêiriére Hospital, Institut Fédératif de Recherche Physiopathologique et Génétique Cardiovasculaire Paris, France
Departments of Biostatistics, Pitié-Salpêiriére Hospital, Institut Fédératif de Recherche Physiopathologique et Génétique Cardiovasculaire Paris, France
revised 10 September 1996; accepted 13 September 1996.
Correspondence: Prof. M. Komajda, Service de Cardiologie, Hôpital Pitié-Salp$trière, 47-83 Boulevard de l'Hôpital. 75013 Paris, France
Abstract
AIMS: Endothelin-1 is a potent vasoconstrictive and multifunctional peptide. Elevated concentrations have been reported in congestive heart failure. We hypothesized that the level of endothelin-1 in plasma is a prognostic marker in congestive heart failure.
METHODS AND RESULTS: Plasma levels of endothelin-1 were measured by radioimmunoassay in 120 congestive heart failure patients with ischaemic or non-ischaemic cardiomyopathy (mean ejection fraction 28±11%, in New York Heart Association (NYHA) functional class I: 21, class II: 35, class III: 61, class IV: 3). During a median follow-up of 361±338 days, 14 cardiac deaths occurred. In the univariate Cox model, endothelin-1 was the most powerful prognostic marker among the variables tested (P=0 0001). A multivariate model, including plasma atrial natriuretic peptide and noradrenaline, NYHA class, age, and echocardiographic left ventricular end-diastolic diameter index was highly predictive of mortality (P=0·00008), but only endothelin-1 remained significantly associated with outcome (P=0·02). Patients with plasma endothelin-1
5 pg . ml–1 had a higher mortality rate than those with endothelin-1<5 pg. ml–1 (21% vs 4%, P=0·001).
CONCLUSION: Our results suggest that elevated endothelin-1 plasma levels are associated with a poor prognosis and routine plasma endothelin-1 determination provides important prognostic information in mild to moderate heart failure.
Key Words: Endothelin-1 • chronic heart failure • prognosis
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