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Plasma endothelin-1 in acute myocardial infarction with heart failure
1Department of Cardiology, School of Medicine, Tokai University, Kanagawa, Japan.
Insights
Elevated levels of endothelin-1, a vasoconstricting substance, correlate with increased circulatory distress in acute myocardial infarction patients. This finding suggests endothelin-1 may worsen cardiac and pulmonary dysfunction during heart attacks.
Area of Science:
- Cardiology
- Vascular Biology
- Biochemistry
Background:
- Endothelin-1 is a potent vasoconstrictor.
- It may exacerbate circulatory dysfunction in acute myocardial infarction (AMI).
Purpose of the Study:
- To investigate the correlation between plasma endothelin-1 levels and the severity of circulatory dysfunction in patients with AMI.
Main Methods:
- Radioimmunoassay was used to measure plasma endothelin-1 in 59 AMI patients and 12 controls.
- Hemodynamic measurements were performed in 16 patients.
- Patients were classified into Killip's classes based on heart failure severity.
Main Results:
- Plasma endothelin-1 levels were significantly elevated in patients with increasing severity of heart failure (Killip's classes II-IV) compared to controls.
- Endothelin-1 levels showed significant positive correlations with mean right atrial pressure, mean pulmonary artery pressure, mean pulmonary artery wedge pressure, and total pulmonary vascular resistance.
- A significant negative correlation was observed between endothelin-1 levels and cardiac index.
Conclusions:
- Plasma endothelin-1 is elevated in AMI patients, with levels increasing proportionally to cardiac and pulmonary circulatory distress.
- Elevated endothelin-1 may contribute to the aggravation of circulatory dysfunction in acute myocardial infarction.
Abstract:
Endothelin-1 is a potent vasoconstricting substance that may aggravate circulatory dysfunction in acute myocardial infarction. In 59 patients with acute myocardial infarction peripheral venous blood was sampled, and endothelin-1 was measured by radioimmunoassay. Hemodynamic measurements were performed with a flow-directed thermodilution catheter in 16 patients. Plasma endothelin-1 levels in Killip's classes were as follows: group I (no heart failure, n = 25), 1.97 +/- 0.69 pg/ml; group II (heart failure, n = 16), 2.74 +/- 1.02 pg/ml; group III (pulmonary edema, n = 13), 4.54 +/- 1.17 pg/ml; and group IV (cardiogenic shock, n = 5), 8.91 +/- 3.16 pg/ml (normal control group, n = 12: 1.51 +/- 0.39 pg/ml). There were significant correlations between the plasma endothelin-1 level and mean right atrial pressure (r = 0.554; p < 0.05), mean pulmonary artery pressure (r = 0.589; p < 0.02), and cardiac index (r = -0.534; p < 0.05). There were closer correlations between plasma endothelin-1 level and mean pulmonary artery wedge pressure (r = 0.678; p < 0.005) and total pulmonary vascular resistance (r = 0.831; p < 0.001). These results indicate that endothelin-1 is elevated in accordance with cardiac and pulmonary circulatory distress in patients with acute myocardial infarction, which may further aggravate circulatory dysfunction.