Association between plasma endothelin-1 levels and Cheyne-Stokes respiration in patients with congestive heart failure.
OBJECTIVE
Elevated plasma endothelin-1 (ET-1) levels have been reported in association with hypoxia and congestive heart failure (CHF). Furthermore, Cheyne-Stokes respiration-central sleep apnea (CSR-CSA) has been found to correlate with the degree of pulmonary hypertension and the severity of CHF; however, the association between ET-1 levels and CSR-CSA has not been investigated previously.


METHODS
Veterans Affairs Medical Center.


METHODS
We studied 46 consecutive patients with CHF (left ventricular function < or = 40%) who underwent right-heart catheterization and overnight polysomnography. Thirty-nine patients completed the study. Sixteen patients (41%) had CSR-CSA, 5 patients (13%) had obstructive apnea, and 18 patients (46%) had no sleep-disordered breathing. Circulating plasma ET-1 levels were assayed in patients with CSR-CSA and in patients with no sleep-disordered breathing using commercially available enzyme-linked immunosorbent assay kits.


RESULTS
ET-1 levels were significantly elevated in patients with CSR-CSA (mean +/- SD, 5.4 +/- 1.3 pg/mL) compared to those without central apnea (3.9 +/- 1.1 pg/mL; p < 0.01), and correlated with mean pulmonary artery pressure (r = 0.66, p < 0.01), pulmonary capillary wedge pressure (r = 0.56, p < 0.03), and central apnea frequency (r = 0.66, p < 0.01). In multivariate analysis, the severity of CSR-CSA was the only variable independently associated with plasma ET-1.


CONCLUSIONS
We conclude that elevated plasma ET-1 levels are linked to the severity of CSR-CSA. Whether ET-1 represents an important pathogenic factor in CSR-CSA or marker of its occurrence requires further evaluation.
El-Solh
Ali A
AA
Department of Medicine, James P. Nolan Clinical Research Center, Erie County Medical Center 124215, USA. sohl@buffalo.edu
Bozkanat
Erkan
E
Mador
Jeffery
J
Grant
Brydon J B
BJ
D000368:Aged; D002639:Cheyne-Stokes Respiration / Q000209:etiology* / Q000503:physiopathology; D019332:Endothelin-1 / Q000097:blood*; D006333:Heart Failure / Q000097:blood* / Q000150:complications* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D020182:Sleep Apnea, Central / Q000209:etiology* / Q000503:physiopathology
D019332:Endothelin-1