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Behavior of circulating endothelin-1 in a group of patients with acute myocardial infarction
S Battistelli1, M Billi, G Manasse
1Istituto di Semeiotica Medica e Geriatria, University of Siena, Italy. battistelli@unisi.it
Insights
Plasma endothelin-1 (ET-1) is elevated in acute myocardial infarction, especially with left ventricular failure. ET-1 levels correlate inversely with left ventricular ejection fraction, suggesting its utility as a disease marker and systolic function index.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Clinical Research
Background:
- Acute myocardial infarction (AMI) is a leading cause of cardiovascular mortality.
- Endothelin-1 (ET-1) is a potent vasoconstrictor peptide with potential roles in cardiovascular pathophysiology.
- Left ventricular (LV) dysfunction is a common complication of AMI, impacting prognosis.
Purpose of the Study:
- To investigate plasma ET-1 levels in patients with AMI, both complicated and uncomplicated by LV failure.
- To assess the dynamic changes in ET-1 during the acute phase and recovery.
- To correlate ET-1 levels with LV systolic function, specifically left ventricular ejection fraction (LVEF), and the impact of thrombolytic therapy.
Main Methods:
- Plasma ET-1 was measured in 23 AMI patients (complicated/uncomplicated LV failure) and 14 controls on admission, days 2, 3, 5, and discharge.
- LV function was assessed on discharge, with moderate to severe dysfunction defined as LVEF < 40%.
- Correlation analyses were performed between ET-1, LV function, and thrombolytic treatment.
Main Results:
- ET-1 was significantly elevated on admission in both uncomplicated (p < 0.01) and complicated (p < 0.001) AMI patients compared to controls.
- In complicated patients, ET-1 remained elevated until discharge, unlike the uncomplicated group which normalized by day 5.
- Plasma ET-1 showed a significant inverse correlation with LVEF (p < 0.001) on discharge, particularly in patients with LVEF < 40% (p < 0.001).
- ET-1 levels were lower in patients receiving thrombolytic therapy (p < 0.05).
Conclusions:
- Early elevation of ET-1 in AMI may reflect ischemia, stress, and hemodynamic impairment.
- Sustained elevation of ET-1 in complicated AMI suggests its role in disease progression.
- Plasma ET-1 serves as a valuable marker for disease severity and a reliable index of LV systolic function post-MI.
Abstract:
The aim of this study was to investigate the behavior of plasma endothelin-1 (ET-1) in 23 patients with acute myocardial infarction, complicated and uncomplicated by left ventricular failure, and treated with and without thrombolytic agents. ET-1 was measured on admission; on days 2, 3, and 5; and again on discharge. In addition, on discharge, ET-1 was correlated with left ventricular systolic function. Left ventricular failure was present, on admission, in 14 patients, whereas the other nine did not have any hemodynamic impairment. On discharge, no patients had left ventricular failure, but 11 had moderate to severe left ventricular systolic dysfunction, defined as left ventricular ejection fraction (LVEF) < 40%. Fourteen subjects, matched for age and sex, served as a control group. Compared with the control range, ET-1 was highly elevated on the first day, in both uncomplicated (p < 0.01) and complicated patients (p < 0.001). Then it decreased rapidly in the uncomplicated group, reaching the control range within day 5, whereas in the complicated group it remained significantly elevated in comparison with both the control subjects and the uncomplicated patients, until discharge. ET-1 was not correlated with the peak of creatine-kinase MB isoenzyme in any group. In seven patients submitted to thrombolytic treatment ET-1 was always significantly lower than in the nonthrombolyzed patients (p < 0.05), but the pattern of variation across time was no different. On discharge, the difference in plasma ET-1 between patients with LVEF < 40% and the control group was significant (p < 0.001), as was the difference between patients with and without moderate to severe systolic dysfunction (p < 0.01). ET-1 was closely and inversely correlated with LVEF when patients were considered as a whole (p < 0.001). These results suggest that the ET-1 increase in the early phase of myocardial infarction could be due to an ischemic process, to stress reaction, and to cardiac hemodynamic impairment, and therefore, ET-1 may be a good marker of disease. In the following phase the ET-1, being correlated with LVEF, could be a reliable index of systolic function.