Prognostic value of plasma endothelin-1 in patients with chronic heart failure

Aims Endothelin-1 is a potent vasoconstrictive and multifunctional peptide. Elevated concentrations have been reported in congestive heart failure. We hypothesized that the level of endothelin-1 in plasma is a prognostic marker in congestive heart failure. Methods and results Plasma levels of endothelin-1 were measured by radioimmunoassay in 120 congestive heart failure patients with ischaemic or non-ischaemic cardiomyopathy (mean ejection fraction 28±11%, in New York Heart Association (NYHA) functional class I: 21, class II: 35, class III: 61, class IV: 3). During a median follow-up of 361±338 days, 14 cardiac deaths occurred. In the univariate Cox model, endothelin-1 was the most powerful prognostic marker among the variables tested ( P =0 0001). A multivariate model, including plasma atrial natriuretic peptide and noradrenaline, NYHA class, age, and echocardiographic left ventricular end-diastolic diameter index was highly predictive of mortality ( P =0·00008), but only endothelin-1 remained significantly associated with outcome ( P =0·02). Patients with plasma endothelin-1≥5 pg . ml−1 had a higher mortality rate than those with endothelin-1<5 pg. ml−1 (21% vs 4%, P =0·001). Conclusion Our results suggest that elevated endothelin-1 plasma levels are associated with a poor prognosis and routine plasma endothelin-1 determination provides important prognostic information in mild to moderate heart failure.