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Raised plasma endothelin in unstable angina and non-Q wave myocardial infarction: relation to cardiovascular outcome
I Wieczorek1, W G Haynes, D J Webb
1Cardiovascular Research Unit, University of Edinburgh.
Insights
High endothelin-1 levels in patients with unstable angina or myocardial infarction may predict future cardiovascular events. Measuring endothelin (ET-1) can help identify high-risk cardiac patients.
Area of Science:
- Cardiology
- Vascular Biology
- Biomarkers
Background:
- Patients with coronary artery disease and unstable angina or non-Q wave myocardial infarction face a high risk of cardiovascular events.
- Accurate prediction of adverse cardiac outcomes requires better identification of relevant biomarkers.
- Endothelin-1 (ET-1), a potent vasoconstrictor peptide derived from endothelium, is implicated in the pathophysiology of acute myocardial ischemia.
Purpose of the Study:
- To investigate whether unstable angina or non-Q wave myocardial infarction are associated with elevated plasma endothelin-1.
- To determine if endothelin-1 concentration at presentation correlates with cardiovascular events within 12 weeks.
- To identify high-risk patients using endothelin-1 as a predictive marker.
Main Methods:
- Prospective investigation of 16 consecutive high-risk patients (unstable angina or non-Q wave myocardial infarction).
- Comparison of plasma endothelin-1 levels at presentation and at nine weeks with a control group of 40 healthy subjects.
- Correlation of endothelin-1 levels with the occurrence of cardiovascular events within 12 weeks.
Main Results:
- Patients exhibited significantly higher mean plasma endothelin-1 at presentation compared to healthy controls (7.4 vs. 5.0 pg/ml, P < 0.0001).
- At nine weeks, plasma endothelin-1 remained significantly elevated in patients who experienced subsequent cardiovascular events (8.5 pg/ml) compared to those with favorable outcomes (5.9 pg/ml).
- Patients with subsequent events showed significantly higher plasma endothelin-1 levels at both presentation and nine weeks compared to those with an uneventful course.
Conclusions:
- Endothelin-1 may play a role in the pathophysiology of acute coronary syndromes.
- Elevated endothelin-1 levels are associated with an increased risk of subsequent cardiovascular events in high-risk cardiac patients.
- Plasma endothelin-1 concentration may serve as a predictive marker for adverse outcomes in unstable angina and non-Q wave myocardial infarction.
Background:
Among patients with independent evidence of coronary disease and recent onset unstable angina or non-Q wave myocardial infarction the incidence of subsequent cardiovascular events is high. Markers predictive of adverse cardiac outcome in unstable angina and non-Q wave myocardial infarction need to be defined more accurately. Endothelin-1 is a potent endothelium derived vasoconstrictor peptide that may play a part in the pathophysiology of acute myocardial ischaemia. AIM AND STUDY DESIGN: In a study that specifically identified high risk patients a group of 16 consecutive patients with either unstable angina at rest or non-Q wave myocardial infarction were prospectively investigated to establish whether these conditions are associated with high plasma immunoreactive endothelin and whether endothelin concentration at presentation is related to cardiovascular events within the next 12 weeks. Controls consisted of a group of 40 healthy subjects.
Results:
Patients had significantly higher mean (SD) plasma endothelin at presentation than did healthy controls (7.4 (1.1) v 5.0 (1.2) pg/ml, P < 0.0001). At nine weeks plasma endothelin was still significantly higher in those patients who had subsequent cardiovascular events, (n = 9, acute myocardial infarction or refractory angina with electrocardiographic changes and revascularisation procedures, 8.5 (2.6) pg/ml, P < 0.005 v controls) whereas its concentration returned to normal in those patients who had a favourable outcome (n = 7, 5.9 (0.7) pg/ml). Compared with those patients who had an uneventful course, patients with subsequent events had significantly higher plasma endothelin, both at presentation and at nine weeks (P < 0.05 on both occasions).
Implications:
Endothelin may contribute to the pathophysiology of acute coronary syndromes and may relate to subsequent cardiovascular outcome.