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Figure 4 Pathophysiological role of endothelin-1 (ET-1) in congestive heart failure. In the heart, ET-1 contributes to contractility. In addition to its vasoconstrictive effects in the systemic and pulmonary circulation, ET-1 leads to hypertrophy of myocardial and smooth muscle cells. The pulmonary circulation is an important source of ET-1 but is also involved in the clearance of ET-1. In the kidney, ET-1 regulates sodium and water excretion. ANP = atrial natriuretic peptide.