Reduced pulmonary clearance of endothelin in congestive heart failure: a marker of secondary pulmonary hypertension
| Autor: | Marc Bois, Jacques Crépeau, Ihor Dyrda, Michel White, Jocelyn Dupuis, Alexandre Caron, Gilbert Gosselin, Raoul Bonan, Joel Lavoie, Cezar Staniloae |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Male medicine.hormone Pulmonary Circulation medicine.medical_specialty Hypertension Pulmonary Indicator Dilution Techniques Hemodynamics Blood Pressure Nerve Tissue Proteins Endothelins Internal medicine medicine.artery Natriuretic Peptide Brain medicine Humans Ventricular Function Pulmonary Wedge Pressure Protein Precursors Pulmonary wedge pressure Lung Aged Aged 80 and over Heart Failure Endothelin-1 business.industry Central venous pressure Middle Aged medicine.disease Pulmonary hypertension Peptide Fragments Blood pressure Heart failure Pulmonary artery Cardiology Regression Analysis Female Cardiology and Cardiovascular Medicine business Biomarkers |
| Zdroj: | Journal of Cardiac Failure. 10:427-432 |
| ISSN: | 1071-9164 |
| DOI: | 10.1016/j.cardfail.2004.01.008 |
| Popis: | Background Endothelin-1 (ET-1) levels are elevated in congestive heart failure (CHF) in relation with the severity of pulmonary hypertension. We evaluated whether a reduced pulmonary ET-1 clearance could contribute to this elevation. Methods and results We determined pulmonary ET-1 clearance in 24 patients with CHF in relation with hemodynamics, plasma ET-1, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Pulmonary ET-1 extraction, measured by the single bolus indicator-dilution technique, was reduced to 32±14% in comparison to historic controls (47±7%). Plasma ET-1 clearance by the lungs (924±588 mL/min) was also much lower than in controls (1424±79 mL/min). Clearance correlated inversely with mean pulmonary artery pressure (PAP, r = −.47, P = .017) and pulmonary capillary wedge pressure ( r = −.47, P = .017) and positively with the rate of left ventricular (LV) relaxation LV −dP/dt ( r = .593, P = .004). After multivariate analysis, only mean PAP and LV −dP/dt were independently correlated with ET-1 clearance ( r = −.40, P = .03, and r = .55, P = .005, respectively). Plasma ET-1 levels did not correlate with clearance ( r = .038, P = .86), and there was no significant arteriovenous ET-1 gradient. There was a mild nonsignificant correlation between plasma ET-1 and pulmonary artery systolic pressure ( r = .38, P = .06), but a strong correlation with right atrial pressure ( r = .696, P r = .51, P = .001), which were maintained after multivariate linear regression ( r = .60, P = .001, and r = .32, P = .04, respectively). Conclusion Pulmonary ET-1 clearance is reduced in CHF in relation with the severity of pulmonary hypertension. This reduced clearance does not significantly modulate plasma ET-1 levels. Whether this is only a marker of secondary pulmonary hypertension or could modulate pulmonary vascular tone will require further studies. |
| Databáze: | OpenAIRE |
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