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European Heart Journal 2001 22(17):1578-1584; doi:10.1053/euhj.2000.2588
Copyright © 2001 by the European Society of Cardiology.
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Increased plasma endothelin levels in angina patients with rapid coronary artery disease progression

E.G. Zouridakisa, R. Schwartzmana, X. Garcia-Molla, I.D. Coxa, S. Fredericksb, D.W. Holtb and J.C. Kaskia,f1

a Coronary Artery Disease Research Unit, Cardiological Sciences, St. George's Hospital Medical School, London, U.K.
b Analytical Unit, Cardiological Sciences, St. George's Hospital Medical School, London, U.K.

revised December 19, 2000; accepted December 20, 2000

Abstract

Aims To investigate the association between plasma endothelin levels and rapid coronary artery disease progression, as assessed by quantitative angiography.

Methods and Results Changes in diameter were assessed in 224 coronary stenoses of 92 consecutive patients (62 men) with chronic stable angina pectoris who were on a waiting list for routine coronary angioplasty and underwent coronary angiography on two occasions: the first (diagnostic) angiogram was carried out at study entry and the second 5·5±3·0 months later, immediately prior to coronary angioplasty. A digital quantitative angiographic analysis system was used to assess differences in stenosis diameter between the first and second angiogram. Plasma immunoreactive endothelin levels were estimated by radioimmunoassy at study entry. Rapid coronary artery disease progression occurred in 29 (31·5%) patients according to pre-established criteria: 12 (41%) had a ≥10% diameter reduction of at least one pre-existing stenosis ≥50%, 10 (34%) had a ≥30% diameter reduction of a pre-existing stenosis <50%, 5 (17%) patients developed a new stenosis and 2 (7%) had progression of a lesion to total occlusion by the second angiogram. Baseline demographic, clinical and angiographic data were similar in patients with and without stenosis progression. Plasma endothelin levels were significantly higher in patients with rapid disease progression than in those without (5·7±2·0pg.ml–1vs 3·9±1·6pg.ml–1, P<0·001). Multiple logistic regression analysis revealed that endothelin was an independent predictor of disease progression (P=0·001). Moreover, endothelin levels above 4·26pg.ml–1(the median of the total endothelin concentrations) were associated with a sixfold increase in the risk of developing rapid stenosis progression.

Conclusions Plasma endothelin is raised in patients with coronary artery disease progression and may be a marker of risk of rapid stenosis progression. Endothelin may also play a pathogenic role in this process.

Key Words: Endothelin, coronary angiography, coronary artery disease progression

f1 Correspondence: Professor Juan Carlos Kaski, Coronary Artery Disease Research Unit, Cardiological Sciences, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, U.K.

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