Identification of chronic heart failure patients with a high 12-month mortality risk using biomarkers including plasma C-terminal pro-endothelin-1.
OBJECTIVE
We hypothesised that assessment of plasma C-terminal pro-endothelin-1 (CT-proET-1), a stable endothelin-1 precursor fragment, is of prognostic value in patients with chronic heart failure (CHF), beyond other prognosticators, including N-terminal pro-B-type natriuretic peptide (NT-proBNP).


METHODS
We examined 491 patients with systolic CHF (age: 63±11 years, 91% men, New York Heart Association [NYHA] class [I/II/III/IV]: 9%/45%/38%/8%, 69% ischemic etiology). Plasma CT-proET-1 was detected using a chemiluminescence immunoassay.


RESULTS
Increasing CT-proET-1 was a predictor of increased cardiovascular mortality at 12-months of follow-up (standardized hazard ratio 1.42, 95% confidence interval [CI] 1.04-1.95, p = 0.03) after adjusting for NT-proBNP, left ventricular ejection fraction (LVEF), age, creatinine, NYHA class. In receiver operating characteristic curve analysis, areas under curve for 12-month follow-up were similar for CT-proET-1 and NT-proBNP (p = 0.40). Both NT-proBNP and CT-proET-1 added prognostic value to a base model that included LVEF, age, creatinine, and NYHA class. Adding CT-proET-1 to the base model had stronger prognostic power (p<0.01) than adding NT-proBNP (p<0.01). Adding CT-proET-1 to NT-proBNP in this model yielded further prognostic information (p = 0.02).


CONCLUSIONS
Plasma CT-proET-1 constitutes a novel predictor of increased 12-month cardiovascular mortality in patients with CHF. High CT-proET-1 together with high NT-proBNP enable to identify patients with CHF and particularly unfavourable outcomes.
Department of Heart Diseases, Wroclaw Military Hospital, Wroclaw, Poland. Ewa.Jankowska@antro.pan.wroc.pl
Ewa A
EA
Jankowska
Gerasimos S
GS
Filippatos
Stephan
S
von Haehling
Jana
J
Papassotiriou
Nils G
NG
Morgenthaler
Mariantonietta
M
Cicoira
Joerg C
JC
Schefold
Piotr
P
Rozentryt
Beata
B
Ponikowska
Wolfram
W
Doehner
Waldemar
W
Banasiak
Oliver
O
Hartmann
Joachim
J
Struck
Andreas
A
Bergmann
Stefan D
SD
Anker
Piotr
P
Ponikowski
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012306:Risk
D015415:Biomarkers; D019332:Endothelin-1; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); C093240:proendothelin 1; D020097:Natriuretic Peptide, Brain
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