title: Superiority of big endothelin-1 and endothelin-1 over natriuretic peptides in predicting survival in severe congestive heart failure: a 7-year follow-up study.
abstract: BACKGROUND
  Plasma concentrations of atrial and brain natriuretic peptides (ANP, BNP), of their N-terminal pro-peptides, of endothelin-1 (ET-1), and big endothelin-1 (big ET-1) have diagnostic and prognostic significance in congestive heart failure (CHF). However, their respective values as a predictor of survival remain controversial and have never been directly compared in severe CHF.
  
  
  RESULTS
  We analyzed, in 47 patients with severe CHF (New York Heart Association [NYHA] class III to IV; age 66 +/- 8 years, ejection fraction 20 +/- 6%), the prognostic performance of a panel of neurohormones and assays (N-terminal pro-ANP 1-25, 68-98 by radioimmunoassay [RIA], and 1-98 by enzyme-linked immunosorbent assay [ELISA], BNP by RIA and immunoradiometric assay [IRMA], N-terminal pro-BNP by Elisa, ET-1 by RIA, and big ET-1 by RIA and Elisa. Data were compared with 40 patients with mild to moderate CHF [NYHA I-II] and 30 healthy subjects. After a follow-up of 81 +/- 15 months, there were 34 deaths and 1 heart transplant. All neurohormones were significantly higher at baseline in patients with severe than in mild to moderate CHF or healthy subjects (all P < .001). Although all neurohormones but BNP IRMA were significant predictors of survival in univariate analysis, only big ET-1 RIA and ET-1 were independent predictors of survival (improvement chi(2): 7.5 and 4.6, P < .01 and P < .05). Using medians as cutpoints of big ET-1 RIA and ET-1, 2 severe CHF populations were defined with a different outcome (5-year survival: 55 versus 18%, P < .01).
  
  
  CONCLUSIONS
  Big ET-1 and ET-1 are strong independent predictors of survival in patients with severe CHF and better for this purpose than natriuretic peptides or their pro-peptides. These markers allow easily to identify a population with a very high risk mortality eligible for more aggressive therapies.
authors.affiliation: Diabetes and Nutrition Unit, Division of Cardiology, School of Public Health, University of Louvain, B-1200 Brussels, Belgium.
authors.forename: Ronald
authors.initials: R
authors.lastname: Van Beneden
authors.forename: Olivier
authors.initials: O
authors.lastname: Gurné
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Selvais
authors.forename: Sylvie A
authors.initials: SA
authors.lastname: Ahn
authors.forename: Annie R
authors.initials: AR
authors.lastname: Robert
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Ketelslegers
authors.forename: Hubert G
authors.initials: HG
authors.lastname: Pouleur
authors.forename: Michel F
authors.initials: MF
authors.lastname: Rousseau
mesh_terms: D009320:Atrial Natriuretic Factor / Q000097:blood*; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D006801:Humans; D015592:Immunoradiometric Assay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis
chemical_list: D019332:Endothelin-1; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor