Can Endothelin-1 Help Address the Diagnostic and Prognostic Challenges in Multimorbid Acute Heart Failure Patients?

Area of Science:

• Cardiology
• Biomarker Research
• Internal Medicine

Background:

• Acute heart failure (AHF) management is complex, particularly in patients with multiple comorbidities.
• Endothelin-1 (ET-1) is implicated in AHF pathogenesis, mediating neurohormonal activation and cardiac remodeling.
• Established biomarkers like NT-proBNP and hs-cTnI have limitations in assessing multimorbid AHF patients.

Purpose of the Study:

• To evaluate the diagnostic and prognostic performance of ET-1 in multimorbid AHF patients.
• To compare ET-1's accuracy against NT-proBNP and hs-cTnI.
• To assess ET-1's independence from comorbidities.

Main Methods:

• Prospective single-center study of 76 patients (54 AHF, 22 controls).
• Plasma ET-1 levels measured via ELISA upon admission.
• Diagnostic and prognostic performance assessed using ROC curve and AUC analysis.

Main Results:

• ET-1 levels were significantly higher in AHF patients (p=0.02) with AUC 0.954, comparable to NT-proBNP (AUC 0.997).
• ET-1 demonstrated the strongest predictive accuracy for in-hospital mortality (AUC=0.781, p=0.026), outperforming NT-proBNP and hs-cTnI.
• ET-1 remained a reliable predictor for 30-day mortality (AUC=0.784, p=0.016) but not for one-year outcomes.
• ET-1 levels were not affected by comorbidities, indicating independent biomarker potential.

Conclusions:

• ET-1 is a valuable biomarker for diagnosing AHF in multimorbid patients.
• ET-1 demonstrates significant prognostic value for short-term mortality in this population.
• ET-1 offers an independent assessment tool, unaffected by the burden of comorbidities.