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Big Endothelin-1 Predicts the long-term survival in patients undergoing septal myectomy
Changpeng Song1, Xiaohong Huang1, Jingang Cui1
1Department of Special Medical Treatment Center, State Key Laboratory of Cardiovascular Disease, 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) predict worse outcomes in patients with obstructive hypertrophic cardiomyopathy (oHCM) after septal myectomy. This finding highlights big ET-1 as a potential prognostic biomarker for oHCM patients.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Outcomes
Background:
- Obstructive hypertrophic cardiomyopathy (oHCM) is a significant cardiovascular condition.
- The prognostic role of endothelin-1 (ET-1) in oHCM patients undergoing septal myectomy is not well-established.
Purpose of the Study:
- To investigate the prognostic significance of plasma big endothelin-1 (ET-1) levels.
- To assess the association between big ET-1 and clinical outcomes in oHCM patients post-myectomy.
Main Methods:
- Analysis of 1207 oHCM patients who underwent septal myectomy.
- Patients categorized into tertiles based on big ET-1 levels.
- Cox regression analyses employed to evaluate the association of big ET-1 with all-cause and cardiovascular mortality.
Main Results:
- Higher big ET-1 levels (highest tertile) were significantly associated with increased all-cause (aHR=3.483) and cardiovascular mortality (aHR=8.328).
- Big ET-1 as a continuous variable also correlated with higher risks of all-cause (aHR=1.588) and cardiovascular deaths (aHR=1.757).
- Interactions between big ET-1 and outcomes were observed in subgroups based on gender and maximum wall thickness.
Conclusions:
- Elevated plasma big ET-1 levels serve as a significant predictor of adverse clinical outcomes in oHCM patients following septal myectomy.
- Big ET-1 may represent a valuable prognostic biomarker for risk stratification in this patient population.
Background:
The prognostic role of endothelin-1 (ET-1) in patients with obstructive hypertrophic cardiomyopathy (oHCM) who underwent septal myectomy remains unclear. We aimed to assess its prognostic importance in patients undergoing septal myectomy.
Methods:
We recruited 1207 oHCM patients for this analysis. The participants were divided into three groups according to the tertile of big ET-1. Cox regression analyses were conducted to assess the prognostic value of big ET-1 on all-cause death and cardiovascular death.
Results:
The mean age of the participants was 49.9 ± 12.0 years, 713 (59%) study patients were male. female (adjusted coefficient 0.106, 95% CI: 0.053-0.158) and left atrial dimension (adjusted coefficient 0.005, 95%CI: 0.001-0.009) were significantly associated with big ET-1 levels. During mean 3.8 years follow-up, 35 patients died including 27 cardiovascular deaths. Multivariate Cox regression analyses showed that patients with highest tertile had the highest incidence of all-cause mortalities (adjusted HR = 3.483, 95% CI: 1.365-8.887, P = 0.009) and cardiovascular mortalities (adjusted HR = 8.328, 95%CI: 1.883-36.828, P = 0.005), compared to the referenced patients with lowest tertile. When Big ET-1 was evaluated as a continuous variable, data showed that the big ET-1 was correlated with higher risks of all-cause deaths (adjusted HR = 1.588, 95%CI: 1.148-2.196, P = 0.005) and cardiovascular deaths (adjusted HR = 1.757, 95%CI: 1.250-2.470, P = 0.001). Furthermore, interactions were detected in the subgroups of gender, and maximum wall thickness.
Conclusion:
Our study revealed that high level of plasma big ET-1 could predict worse clinical outcomes for oHCM patients undergoing myectomy.
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