title: Systematic Evaluation of Endothelin 1 Measurement Relative to Traditional and Modern Biomarkers for Clinical Assessment and Prognosis in Patients With Chronic Systolic Heart Failure: Serial Measurement and Multimarker Testing.
abstract: OBJECTIVE
  To define the role of single or serial measurement of endothelin 1 (ET-1) for prognostication beyond traditional and modern markers of risk in heart failure (HF).
  
  
  METHODS
  In total, 115 patients with chronic systolic HF were followed for 10 months. Clinical assessment and ET-1, N-terminal pro-B-type natriuretic peptide (NT-proBNP), highly sensitive troponin I (hsTnI), soluble ST2 (sST2), and galectin 3 were measured at each visit.
  
  
  RESULTS
  Elevated ET-1 was associated with worse HF, lower right ventricular function, higher pulmonary pressure, and higher left atrial volume index despite similar left ventricular function. ET-1 correlated with angiotensin-converting enzyme inhibitor use. A model containing traditional risk factors, ET-1, NT-proBNP, hsTnI, and sST2 best predicted cardiovascular events, and ET-1 improved reclassification. In an adjusted time-integrated model, percent time spent with ET-1 of 5.90 pg/mL or less was predictive of fewer cardiovascular events (odds ratio, 0.75; 95% confidence interval, 0.62-0.91). ET-1 reduction over time was associated with a lower rate of cardiovascular events compared with increasing or stable ET-1 (24.4% vs 50.0%).
  
  
  CONCLUSIONS
  ET-1 may be a unique predictor of HF prognosis, complementing other biomarkers in a multimarker profile. Serial measurement of ET-1 may provide additional prognostic information.
authors.affiliation: Massachusetts General Hospital, Boston.|Baim Institute for Clinical Research, Boston, MA.
authors.forename: Hanna K
authors.initials: HK
authors.lastname: Gaggin
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Parul U
authors.initials: PU
authors.lastname: Gandhi
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Shweta R
authors.initials: SR
authors.lastname: Motiwala
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Arianna M
authors.initials: AM
authors.lastname: Belcher
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Rory B
authors.initials: RB
authors.lastname: Weiner
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Baggish
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002908:Chronic Disease; D004452:Echocardiography; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D054143:Heart Failure, Systolic / Q000097:blood*; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models
chemical_list: D015415:Biomarkers; D019332:Endothelin-1; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Endothelin; Heart failure; Monitoring; Multimarker panel; Prognosis; Systolic