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Published on: September 22, 2020
Endothelin-1 levels predict 3-year survival in patients who have amputation for critical leg ischaemia
D J Newton1, F Khan, M McLaren
1Vascular Diseases Research Unit, Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. d.j.newton@dundee.ac.uk
Insights
Endothelin-1 (ET-1) levels predict mortality in critical leg ischaemia (CLI) patients. Higher ET-1 indicates increased risk of death from all causes and cardiovascular events in CLI patients.
Area of Science:
- Vascular Medicine
- Cardiovascular Research
- Biomarker Discovery
Background:
- Critical leg ischaemia (CLI) patients often have co-existing coronary heart disease, a major contributor to mortality.
- Identifying predictive markers for mortality in CLI is crucial for patient management.
Purpose of the Study:
- To investigate endothelial function markers as predictors of mortality in patients with critical leg ischaemia.
- To determine if specific biomarkers can identify CLI patients at higher risk of death.
Main Methods:
- A cohort of 39 CLI patients scheduled for lower-limb amputation was studied.
- Blood levels of vascular endothelial growth factor, homocysteine, endothelin-1 (ET-1), von Willebrand factor, and vascular cell adhesion molecule-1 were measured.
- Forearm vascular responses to acetylcholine, an endothelium-dependent vasodilator, were assessed.
Main Results:
- Significantly higher levels of endothelin-1 (ET-1) were observed in patients who died within 3 years compared to survivors (P = 0.002).
- Cox regression analysis identified ET-1 as an independent predictor of all-cause mortality (hazard ratio 3.53; P = 0.007).
- ET-1 also independently predicted cardiovascular mortality (hazard ratio 4.15; P = 0.014).
Conclusions:
- Endothelin-1 (ET-1) is an independent predictor of mortality in patients with critical leg ischaemia (CLI).
- Measuring ET-1 levels may aid in risk stratification for CLI patients.
- These findings highlight the role of endothelial dysfunction in CLI outcomes.
Background:
Most patients with critical leg ischaemia (CLI) have co-existing coronary heart disease, which is the main cause of their increased mortality rate. The aim of this study was to investigate whether any markers of endothelial function could predict death in these patients.
Methods:
In a cohort of 39 patients with CLI who were scheduled for lower-limb amputation, blood levels of vascular endothelial growth factor, homocysteine, endothelin (ET) 1, von Willebrand factor and vascular cell adhesion molecule 1 were measured, as well as forearm vascular responses to the endothelium-dependent vasodilator acetylcholine.
Results:
Levels of ET-1 were significantly higher in patients who subsequently died within 3 years than in those who were still alive (P = 0.002) and Cox proportional hazards regression analysis demonstrated that ET-1 was an independent predictor of all-cause mortality:hazard ratio 3.53 (95 per cent confidence interval (c.i.) 1.29 to 9.70; P = 0.007) and cardiovascular mortality:hazard ratio 4.15 (95 per cent c.i. 1.30 to 13.23); P = 0.014.
Conclusion:
ET-1 was an independent predictor of death in these patients with CLI.
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