CLINICAL STUDIES
Value of cardiopulmonary exercise testing and big endothelin plasma levels to predict short-term prognosis of patients with chronic heart failure
Martin Hülsmann, MD*,
Brigitte Stanek, MD*,
Bernhard Frey, MD*,
Barbara Sturm, MD*,
Dinah Putz, MD**,
Thomas Kos, MD*,
Rudolf Berger, MD*,
Wolfgang Woloszczuk, PhD ,
Gerald Maurer, MD, FACC* and
Richard Pacher, MD* **
* Department of Cardiology, University of Vienna, Vienna, Austria
** Department of Nephrology, University of Vienna, Vienna, Austria
Department of Ludwig Boltzmann Institute for Experimental Endocrinology, University of Vienna, Vienna, Austria
Manuscript received February 19, 1998;
revised manuscript received July 20, 1998,
accepted July 22, 1998.
Address for correspondence: Dr. Martin Hülsmann, Department of Cardiology, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
Objectives. We tested the hypothesis that, in patients with stable heart failure, measuring big endothelin-1 (ET-1) plasma level at rest predicts short-term prognosis better than peak oxygen consumption (VO2max) at exercise.
Background. Cardiopulmonary exercise testing and evaluation of neurohumoral plasma factors are established tools to estimate survival in patients with heart failure. No data, however, exist comparing the prognostic value of both marker categories simultaneously.
Methods. Two hundred twenty-six heart failure patients were studied in regard to a combined end point of death and prioritization for urgent cardiac transplantation within 1 year follow-up.
Results. During the study period 149 patients were without cardiac events (group A), 69 patients died or were urgently transplanted (group B) and 8 patients were alive after a nonurgent heart transplant operation. Norepinephrine (p < 0.0001), atrial natriuretic peptide (p < 0.001), big endothelin plasma levels (p < 0.0001 as well as workload, VO2max and achieved percentage of predicted peak oxygen consumption (pVo2max) (all p < 0.0001) differed significantly between groups A and B. In multivariate stepwise regression analysis, however, only big ET-1 plasma concentration (x2 = 74.4, p < 0.0001), New York Heart Association function class (x2 = 33.9, p < 0.0001), maximal workload (x2 = 7.2, p < 0.01, and plasma atrial natriuretic peptide (ANP) concentration (x2 = 4.6, p < 0.05) were independently related to outcome. Peak oxygen consumption or pVO2max did not reach statistical significance in this model. Event-free survival rates were significantly lower in patients with a big ET-1 level of 4.3 fmol/ml or more than with lower big ET-1 levels (p < 0.0001).
Conclusion. We conclude that in patients with chronic heart failure who are stable on oral therapy measuring big ET-1 and ANP plasma levels may be a valuable noninvasive adjunct to improve the prognostic accuracy of detecting high risk patients compared with exercise testing alone.
|
Abbreviations and Acronyms
| | ACE | = angiotensin converting enzyme | | ANP | = atrial natriuretic peptide | | ET-1 | = endothelin-1 | | HTx | = heart transplantation | | LVEF | = left ventricular ejection fraction | | NYHA | = New York Heart Association | | pVO2max | = percentage of predicted VO2max | | VCO2 | = carbon dioxide production | | VE | = ventilation | | VO2max | = peak oxygen consumption |
|
This article has been cited by other articles:
|
|
|
|
 
E. Braunwald
Biomarkers in Heart Failure
N. Engl. J. Med.,
May 15, 2008;
358(20):
2148 - 2159.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Kubanek, I. Malek, J. Bytesnik, P. Fridl, L. Riedlbauchova, L. Karasova, V. Lanska, and J. Kautzner
Decrease in plasma B-type natriuretic peptide early after initiation of cardiac resynchronization therapy predicts clinical improvement at 12 months
Eur J Heart Fail,
December 1, 2006;
8(8):
832 - 840.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Roig
Usefulness of neurohormonal markers in the diagnosis and prognosis of heart failure
Eur. Heart J. Suppl.,
September 1, 2006;
8(suppl_E):
E12 - E17.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Kubanek, I. Malek, J. Kautzner, M. Hegarova, M. Wiendl, P. Lupinek, L. Karasova, and V. Lanska
The value of B-type natriuretic peptide and big endothelin-1 for detection of severe pulmonary hypertension in heart transplant candidates
Eur J Heart Fail,
December 1, 2005;
7(7):
1149 - 1155.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Meyer, D. Mortl, K. Strecker, M. Hulsmann, V. Kulemann, T. Neunteufl, R. Pacher, and R. Berger
Flow-Mediated Vasodilation Predicts Outcome in Patients With Chronic Heart Failure: Comparison With B-Type Natriuretic Peptide
J. Am. Coll. Cardiol.,
September 20, 2005;
46(6):
1011 - 1018.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. de Denus, C. Pharand, and D. R. Williamson
Brain Natriuretic Peptide in the Management of Heart Failure: The Versatile Neurohormone
Chest,
February 1, 2004;
125(2):
652 - 668.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Hulsmann, M. Quittan, R. Berger, R. Crevenna, C. Springer, M. Nuhr, D. Mortl, P. Moser, and R. Pacher
Muscle strength as a predictor of long-term survival in severe congestive heart failure
Eur J Heart Fail,
January 1, 2004;
6(1):
101 - 107.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Rich and V. V. McLaughlin
Endothelin Receptor Blockers in Cardiovascular Disease
Circulation,
November 4, 2003;
108(18):
2184 - 2190.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Bittner
Exercise testing in heart failure: Maximal, submaximal, or both?
J. Am. Coll. Cardiol.,
July 2, 2003;
42(1):
123 - 125.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. G Lainchbury and A M. Richards
EXERCISE TESTING IN THE ASSESSMENT OF CHRONIC CONGESTIVE HEART FAILURE
Heart,
December 1, 2002;
88(5):
538 - 543.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D.P. Nicholls, C. O'Dochartaigh, and M.S. Riley
Circulatory power--a new perspective on an old friend
Eur. Heart J.,
August 2, 2002;
23(16):
1242 - 1245.
[PDF]
|
|
|
|
|
|
|
M. Hulsmann, R. Berger, B. Sturm, A. Bojic, W. Woloszczuk, J. Bergler-Klein, and R. Pacher
Prediction of outcome by neurohumoral activation, the six-minute walk test and the Minnesota Living with Heart Failure Questionnaire in an outpatient cohort with congestive heart failure
Eur. Heart J.,
June 1, 2002;
23(11):
886 - 891.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Hurlimann, F. Ruschitzka, and T.F. Luscher
The relationship between the endothelium and the vessel wall
Eur. Heart J. Suppl.,
February 1, 2002;
4(suppl_A):
A1 - A7.
[Abstract]
[PDF]
|
|
|
|
|
|
|
B. Stanek, B. Frey, M. Hulsmann, R. Berger, B. Sturm, J. Strametz-Juranek, J. Bergler-Klein, P. Moser, A. Bojic, E. Hartter, et al.
Prognostic evaluation of neurohumoral plasma levels before and during beta-blocker therapy in advanced left ventricular dysfunction
J. Am. Coll. Cardiol.,
August 1, 2001;
38(2):
436 - 442.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Chanda and C. C. Canver
Reversal of preexisting vasospasm in coronary artery conduits
Ann. Thorac. Surg.,
August 1, 2001;
72(2):
476 - 480.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R.J. Irving, J.P. Noon, G.C.M. Watt, D.J. Webb, and B.R. Walker
Activation of the endothelin system in insulin resistance
QJM,
June 1, 2001;
94(6):
321 - 326.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. E. Spieker, G. Noll, F. T. Ruschitzka, and T. F. Luscher
Endothelin receptor antagonists in congestive heart failure: a new therapeutic principle for the future?
J. Am. Coll. Cardiol.,
May 1, 2001;
37(6):
1493 - 1505.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Berger, B. Stanek, M. Hulsmann, B. Frey, S. Heher, R. Pacher, and T. Neunteufl
Effects of Endothelin A Receptor Blockade on Endothelial Function in Patients With Chronic Heart Failure
Circulation,
February 20, 2001;
103(7):
981 - 986.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. L. Moraes, W. S. Colucci, and M. M. Givertz
Secondary Pulmonary Hypertension in Chronic Heart Failure : The Role of the Endothelium in Pathophysiology and Management
Circulation,
October 3, 2000;
102(14):
1718 - 1723.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Frey, R. Pacher, G. Locker, A. Bojic, E. Hartter, W. Woloszczuk, and B. Stanek
Prognostic Value of Hemodynamic vs Big Endothelin Measurements During Long-term IV Therapy in Advanced Heart Failure Patients
Chest,
June 1, 2000;
117(6):
1713 - 1719.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
