title: Value of cardiopulmonary exercise testing and big endothelin plasma levels to predict short-term prognosis of patients with chronic heart failure.
abstract: OBJECTIVE
  We tested the hypothesis that, in patients with stable heart failure, measuring big endothelin-1 (ET-1) plasma level at rest predicts short-term prognosis better than peak oxygen consumption (VO2max) at exercise.
  
  
  BACKGROUND
  Cardiopulmonary exercise testing and evaluation of neurohumoral plasma factors are established tools to estimate survival in patients with heart failure. No data, however, exist comparing the prognostic value of both marker categories simultaneously.
  
  
  METHODS
  Two hundred twenty-six heart failure patients were studied in regard to a combined end point of death and prioritization for urgent cardiac transplantation within 1 year follow-up.
  
  
  RESULTS
  During the study period 149 patients were without cardiac events (group A), 69 patients died or were urgently transplanted (group B) and 8 patients were alive after a nonurgent heart transplant operation. Norepinephrine (p < 0.0001), atrial natriuretic peptide (p < 0.001), big endothelin plasma levels (p < 0.0001 as well as workload, VO2max and achieved percentage of predicted peak oxygen consumption (pVO2max) (all p < 0.0001) differed significantly between groups A and B. In multivariate stepwise regression analysis, however, only big ET-1 plasma concentration (chi2=74.4, p < 0.0001), New York Heart Association function class (chi2=33.9, p < 0.0001), maximal workload (chi2=7.2, p < 0.01, and plasma atrial natriuretic peptide (ANP) concentration (chi2=4.6, p < 0.05) were independently related to outcome. Peak oxygen consumption or pVO2max did not reach statistical significance in this model. Event-free survival rates were significantly lower in patients with a big ET-1 level of 4.3 fmol/ml or more than with lower big ET-1 levels (p < 0.0001).
  
  
  CONCLUSIONS
  We conclude that in patients with chronic heart failure who are stable on oral therapy measuring big ET-1 and ANP plasma levels may be a valuable noninvasive adjunct to improve the prognostic accuracy of detecting high risk patients compared with exercise testing alone.
authors.affiliation: Department of Cardiology, University of Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Hülsmann
authors.forename: B
authors.initials: B
authors.lastname: Stanek
authors.forename: B
authors.initials: B
authors.lastname: Frey
authors.forename: B
authors.initials: B
authors.lastname: Sturm
authors.forename: D
authors.initials: D
authors.lastname: Putz
authors.forename: T
authors.initials: T
authors.lastname: Kos
authors.forename: R
authors.initials: R
authors.lastname: Berger
authors.forename: W
authors.initials: W
authors.lastname: Woloszczuk
authors.forename: D
authors.initials: D
authors.lastname: Putz
authors.forename: T
authors.initials: T
authors.lastname: Kos
authors.forename: R
authors.initials: R
authors.lastname: Berger
authors.forename: W
authors.initials: W
authors.lastname: Woloszczuk
authors.forename: G
authors.initials: G
authors.lastname: Maurer
authors.forename: R
authors.initials: R
authors.lastname: Pacher
mesh_terms: D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D019332:Endothelin-1; D016232:Endothelins / Q000097:blood*; D005080:Exercise Test / Q000592:standards*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011498:Protein Precursors / Q000097:blood*; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D019332:Endothelin-1; D016232:Endothelins; D011498:Protein Precursors