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Increased mortality with elevated plasma endothelin-1 in acute heart failure: an ASCEND-HF biomarker substudy.

Publication ,  Journal Article
Perez, AL; Grodin, JL; Wu, Y; Hernandez, AF; Butler, J; Metra, M; Felker, GM; Voors, AA; McMurray, JJ; Armstrong, PW; Starling, RC; Tang, WHW ...
Published in: Eur J Heart Fail
March 2016

AIMS: Endothelin-1 (ET-1) is an endogenous vasoconstrictor implicated in pulmonary and systemic hypertension, as well as ventricular dysfunction, through effects on vascular smooth muscle, the kidneys, and cardiomyocytes. We aimed to determine the association between serial ET-1 levels and acute heart failure patient outcomes. METHODS AND RESULTS: We measured plasma ET-1 at baseline, 48-72 h, and 30 days in a cohort of 872 patients hospitalized with acute heart failure from the ASCEND-HF trial (randomized to nesiritide vs. placebo), and its association with 30-day mortality, 180-day mortality, in-hospital death or worsening heart failure, and 30-day mortality or rehospitalization. Median ET-1 was 7.6 [interquartile range (IQR) 5.9-10] pg/mL at baseline, 6.3 (IQR 4.9-8.1) pg/mL at 48-72 h, and 5.9 (IQR 4.7-7.9) pg/mL at 30 days (P < 0.001). Baseline and 48-72 h ET-1 were found to be independently associated with 180-day mortality in a multivariable analysis [hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.3-2.0, P < 0.001 and HR 1.5, 95% CI 1.2-1.9, P = 0.001, respectively, log-transformed]. ET-1 that was measured at 48-72 h was also independently associated with death or worsening heart failure prior to discharge [odds ratio (OR) 1.6, 95% CI 1.03-2.4, P = 0.03]. These independent associations remained significant after including NT-proBNP in the multivariable analysis. CONCLUSIONS: We observed an independent association between elevated ET-1 and short-term in-hospital clinical outcomes and 180-day mortality in hospitalized patients with acute heart failure ET-1 provided additional prognostic information which was incremental to that yielded by NT-proBNP.

Duke Scholars

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

March 2016

Volume

18

Issue

3

Start / End Page

290 / 297

Location

England

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Prognosis
  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Middle Aged
  • Male
  • Humans
  • Hospital Mortality
  • Heart Failure
  • Female
 

Citation

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Perez, A. L., Grodin, J. L., Wu, Y., Hernandez, A. F., Butler, J., Metra, M., … Tang, W. H. W. (2016). Increased mortality with elevated plasma endothelin-1 in acute heart failure: an ASCEND-HF biomarker substudy. Eur J Heart Fail, 18(3), 290–297. https://doi.org/10.1002/ejhf.456
Perez, Antonio L., Justin L. Grodin, Yuping Wu, Adrian F. Hernandez, Javed Butler, Marco Metra, G Michael Felker, et al. “Increased mortality with elevated plasma endothelin-1 in acute heart failure: an ASCEND-HF biomarker substudy.Eur J Heart Fail 18, no. 3 (March 2016): 290–97. https://doi.org/10.1002/ejhf.456.
Perez AL, Grodin JL, Wu Y, Hernandez AF, Butler J, Metra M, et al. Increased mortality with elevated plasma endothelin-1 in acute heart failure: an ASCEND-HF biomarker substudy. Eur J Heart Fail. 2016 Mar;18(3):290–7.
Perez, Antonio L., et al. “Increased mortality with elevated plasma endothelin-1 in acute heart failure: an ASCEND-HF biomarker substudy.Eur J Heart Fail, vol. 18, no. 3, Mar. 2016, pp. 290–97. Pubmed, doi:10.1002/ejhf.456.
Perez AL, Grodin JL, Wu Y, Hernandez AF, Butler J, Metra M, Felker GM, Voors AA, McMurray JJ, Armstrong PW, Starling RC, O’Connor CM, Tang WHW. Increased mortality with elevated plasma endothelin-1 in acute heart failure: an ASCEND-HF biomarker substudy. Eur J Heart Fail. 2016 Mar;18(3):290–297.
Journal cover image

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

March 2016

Volume

18

Issue

3

Start / End Page

290 / 297

Location

England

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Prognosis
  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Middle Aged
  • Male
  • Humans
  • Hospital Mortality
  • Heart Failure
  • Female