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Prognostic value of plasma big endothelin-1 in left ventricular non-compaction cardiomyopathy
Peng Fan1, Ying Zhang1, Yi-Ting Lu1
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
High levels of big endothelin-1 (ET-1) are associated with adverse outcomes in patients with left ventricular non-compaction cardiomyopathy (LVNC). This finding suggests big ET-1 is a valuable prognostic marker for LVNC patients.
Area of Science:
- Cardiology
- Biomarkers
- Cardiovascular Research
Background:
- Left ventricular non-compaction cardiomyopathy (LVNC) is a rare congenital heart defect.
- The prognostic factors for LVNC are not fully understood.
- Endothelin-1 (ET-1) is a potent vasoconstrictor implicated in cardiovascular disease.
Purpose of the Study:
- To investigate the prognostic significance of plasma big endothelin-1 (big ET-1) levels in patients diagnosed with LVNC.
- To determine if big ET-1 can predict adverse clinical outcomes in LVNC.
- To establish big ET-1 as a potential biomarker for risk stratification in LVNC.
Main Methods:
- Prospective enrollment of LVNC patients diagnosed via cardiac MRI with available big ET-1 data.
- Primary endpoint: composite of all-cause mortality, heart transplantation, sustained ventricular tachycardia/fibrillation, and ICD discharge.
- Secondary endpoint: cardiac death or heart transplantation. Analysis included Kaplan-Meier and Cox regression.
Main Results:
- 203 patients (70.9% male, median age 44) were stratified into high (≥0.42 pmol/L) and low (<0.42 pmol/L) big ET-1 groups.
- High big ET-1 levels correlated with increased left ventricular diameter and N-terminal pro-brain natriuretic peptide, and decreased ejection fraction.
- High big ET-1 was significantly associated with increased risk for both primary (p<0.001) and secondary (p<0.001) endpoints, acting as an independent predictor.
Conclusions:
- Plasma big endothelin-1 (big ET-1) is a significant independent predictor of adverse clinical outcomes in patients with LVNC.
- Elevated big ET-1 levels may serve as a valuable prognostic index for risk stratification in LVNC.
- Further research can explore therapeutic targeting of the ET-1 pathway in LVNC.
Objective:
To determine the prognostic role of big endothelin-1 (ET-1) in left ventricular non-compaction cardiomyopathy (LVNC).
Methods:
We prospectively enrolled patients whose LVNC was diagnosed by cardiac MRI and who had big ET-1 data available. Primary end point was a composite of all-cause mortality, heart transplantation, sustained ventricular tachycardia/fibrillation and implanted cardioverter defibrillator discharge. Secondary end point was cardiac death or heart transplantation.
Results:
Altogether, 203 patients (median age 44 years; 70.9% male) were divided into high-level (≥0.42 pmol/L) and low-level (<0.42 pmol/L) big ET-1 groups according to the median value of plasma big ET-1 levels. Ln big ET-1 was positively associated with Ln N-terminal pro-brain natriuretic peptide, left ventricular diameter, but negatively related to age and Ln left ventricular ejection fraction. Median follow-up was 1.9 years (IQR 0.9-3.1 years). Kaplan-Meier analysis showed that, compared with patients with low levels of big ET-1, those with high levels were at greater risk for meeting both primary (p<0.001) and secondary (p<0.001) end points. The C-statistic estimation of Ln big ET-1 for predicting the primary outcome was 0.755 (95% CI 0.685 to 0.824, p<0.001). After adjusting for confounding factors, Ln big ET-1 was identified as an independent predictor of the composite primary outcome (HR 1.83, 95% CI 1.27 to 2.62, p=0.001) and secondary outcome (HR 1.93, 95% CI 1.32 to 2.83, p=0.001).
Conclusions:
Plasma big ET-1 may be a valuable index to predict the clinical adverse outcomes in patients with LVNC.
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