title: Usefulness of endothelin-1 assessment in acute myocardial infarction.
abstract: OBJECTIVE
  High endothelin-1 (ET-1) levels have been linked to poor clinical outcomes after ST-segment elevation myocardial infarction (STEMI). Vasoconstriction of the coronary microcirculation seems to be the underlying mechanism. The aim of the study was to assess the effect of ET-1 on microvascular integrity, infarct size, left ventricular ejection fraction (LVEF) and myocardial salvage in evolving myocardial infarction (MI).
  
  
  METHODS
  We measured ET-1 levels acutely (6-24h) in 127 patients presenting with their first STEMI. Contrast-enhanced cardiac magnetic resonance (ce-CMR) was performed in 94 patients within 1 week to assess microvascular obstruction (MO), infarct size and LVEF. A myocardial salvage index (MSI) was defined as the percentage of at-risk angiographic area without necrosis on the ce-CMR.
  
  
  RESULTS
  Mean age was 60.9 ± 11.8 years and 98 (77%) were males. Median ET-1 level within the first 24h was 6.8 pg/mL (25(th) -75(th) percentile range: 5.4-8.5 pg/mL). Patients with ET-1 concentrations over the median presented higher percentage of MO (77.7% for ET-1>6.8 pg/mL vs. 16.6% for ET-1 ≤ 6.8 pg/mL, P<.001) and lower MSI values (13.8 ± 26% for ET-1>6.8 pg/mL vs. 37.4 (26%) for ET-1 ≤ 6.8 pg/mL, P=.02). ET-1 levels did not show a significant association with infarct size (P=.11) and LVEF (P=.16). Multivariate analysis found ET-1 to be a significant predictor of MO (OR=2.78; CI 95% 1.16-6.66; P=.021) and MSI ≤ Percentile 25 (OR=1.69, CI 95% 1.01-2.81; P=.04).
  
  
  CONCLUSIONS
  High ET-1 levels after myocardial infarction are associated with the presence of microvascular obstruction and lower myocardial salvage index.
authors.affiliation: Servicio de Cardiología, Instituto del Tórax, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, España. freixa@clinic.ub.es
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.forename: Magda
authors.initials: M
authors.lastname: Heras
authors.forename: José T
authors.initials: JT
authors.lastname: Ortiz
authors.forename: Sergio
authors.initials: S
authors.lastname: Argiró
authors.forename: Eduard
authors.initials: E
authors.lastname: Guasch
authors.forename: Adelina
authors.initials: A
authors.lastname: Doltra
authors.forename: Marcelo
authors.initials: M
authors.lastname: Jiménez
authors.forename: Amadeo
authors.initials: A
authors.lastname: Betriu
authors.forename: Mónica
authors.initials: M
authors.lastname: Masotti
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D002196:Capillaries / Q000473:pathology; D004562:Electrocardiography; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis*; D009206:Myocardium / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D015415:Biomarkers; D019332:Endothelin-1