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European Heart Journal 2003 24(4):346-355; doi:10.1016/S0195-668X(02)00420-7
Copyright © 2003 by the European Society of Cardiology.
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Relationship between transcardiac gradient of endothelin-1 and left ventricular remodelling in patients with first anterior myocardial infarction

T. Tsutamoto*, A. Wada, M. Hayashi, T. Tsutsui, K. Maeda, M. Ohnishi, M. Fujii, T. Matsumoto, T. Yamamoto, T. Takayama, C. Ishii and M. Kinoshita

First Department of Internal Medicine, Shiga University of Medical Science, Seta-Tsukinowa,Otsu 520-2192, Japan

Received May 23, 2002; accepted June 12, 2002 * Corresponding author. Tel.: +81-775-48-2213; fax: +81-775-43-5839
tutamoto{at}belle.shiga-med.ac.jp

Aims To evaluate whether plasma endothelin-1 (ET-1) is extracted or produced through the heart in patients with acute myocardial infarction (AMI), and the relationship between transcardiac extraction of plasma ET-1 and left ventricular (LV) remodelling.

Methods and results We measured the plasma level of ET-1 in the aortic root (Ao) and coronary sinus (CS) in 48 consecutive patients, who received successful revascularization and enalapril, for a first anterior AMI. In the acute phase the plasma ET-1 level was significantly higher both in the Ao and the CS compared to the control subjects. However, the plasma ET-1 level was significantly lower in the CS than in the Ao in the acute phase and after 1 month. There were significant correlations between transcardiac extraction of ET-1 in the acute phase and LV ejection fraction and LV end-diastolic volume index (LVEDVI) after 1 month. Stepwise multivariate analysis showed that maximal creatine phosphokinase and transcardiac extraction of plasma ET-1 during the acute phase were independently and positively correlated with the absolute change in LVEDVI after 1 month.

Conclusions These results indicate that elevated circulating ET-1 is extracted through the heart in patients with a first anterior AMI and that the extracted ET-1 plays a significant role in modulating post-infarct LV remodelling.

Key Words: Acute myocardial infarction • Endothelin-1 • Brain natriuretic peptide • Ventricular remodelling


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