The Prognostic Value of Big Endothelin-1 in More Than 2,300 Patients With Heart Failure Enrolled in the Valsartan Heart Failure Trial (Val-HeFT)
| Autor: | Simona Barlera, Giampaolo Perini, Jay N. Cohn, Inder S. Anand, Gianni Tognoni, Roberto Latini, Monica Salio, Serge Masson, Dianne Judd, Francesco Perticone |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty New York Heart Association Class medicine.drug_class Cardiac Output Low Severity of Illness Index Internal medicine Natriuretic Peptide Brain Natriuretic peptide Humans Multicenter Studies as Topic Medicine Aged Proportional Hazards Models Randomized Controlled Trials as Topic Endothelin-1 business.industry Proportional hazards model Osmolar Concentration Hazard ratio Atrial fibrillation Middle Aged Prognosis medicine.disease Brain natriuretic peptide Valsartan Heart failure Chronic Disease Cardiology Female Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Journal of Cardiac Failure. 12:375-380 |
| ISSN: | 1071-9164 |
| DOI: | 10.1016/j.cardfail.2006.02.013 |
| Popis: | Endothelin is elevated in heart failure and contributes to neurohormonal activation, hemodynamic deterioration, and cardiovascular remodeling. Here, we examined its prognostic value in a large population of patients with chronic heart failure.Big endothelin-1 (Big ET-1) and 4 other neurohormones were measured at study entry in 2359 patients enrolled in the Valsartan Heart Failure Trial (Val-HeFT) and their concentrations related to outcome over a median follow-up of 23 months. Baseline concentration of Big ET-1 (median 0.80 pmol/L) was proportional to severity of disease (New York Heart Association class, left ventricular structure and function). High circulating concentrations of brain natriuretic peptide (BNP), creatinine and bilirubin, advanced New York Heart Association class, elevated body mass index, and the presence of atrial fibrillation were independently associated to higher concentrations of Big ET-1. Big ET-1 (ranking second just behind BNP among neurohormonal factors) was an independent predictor of outcome defined as all-cause mortality (hazard ratio 1.49, 95% CI 1.20-1.84, P = .0003) or the combined endpoint of mortality and morbidity (hazard ratio 1.43, 95% CI 1.20-1.69, P.0001) and provided incremental prognostic value compared with BNP.In a large population of patients with symptomatic heart failure, the circulating concentration of Big ET-1, a precursor of the paracrine and bioactive peptide ET-1, was an independent marker of mortality and morbidity. In this setting, BNP remained the strongest neurohormonal prognostic factor. |
| Databáze: | OpenAIRE |
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