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Changes of endothelin-1 and atrial natriuretic peptide during dobutamine stress echocardiography
W J Cherng1, C H Wang, M J Hung
1Department of Medicine, Chang-Gung Memorial Hospital at Keelung, Chang-Gung Medical College, Keelung, Taiwan.
Insights
Plasma endothelin-1 (ET-1) and atrial natriuretic peptide (ANP) may predict coronary artery disease in patients with suspected ischemic heart disease. However, ET-1 does not appear to play a role during an ischemic attack.
Area of Science:
- Cardiology
- Biochemistry
- Diagnostic Imaging
Background:
- Ischemic heart disease diagnosis relies on assessing myocardial ischemia and left ventricular (LV) dysfunction.
- Endothelin-1 (ET-1) and atrial natriuretic peptide (ANP) are vasoactive peptides implicated in cardiovascular regulation.
- Their role in the context of dobutamine stress echocardiography in ischemic heart disease requires further elucidation.
Purpose of the Study:
- To test the hypothesis that plasma ET-1 and ANP concentrations correlate with myocardial ischemia or LV dysfunction during dobutamine stress echocardiography.
- To investigate the predictive value of ET-1 and ANP in patients with suspected ischemic heart disease.
Main Methods:
- Plasma ET-1 and ANP levels were measured in three groups of patients undergoing dobutamine stress echocardiography: normal (Group I), positive stress with preserved LVEF (Group II), and positive stress with reduced LVEF (Group III).
- Thallium-201 scintigraphy and coronary angiography were performed.
- LV end-diastolic pressure and LVEF were assessed.
Main Results:
- Resting ET-1 concentrations were higher in Groups II and III compared to Group I.
- Resting ANP concentration was significantly higher in Group III than in Groups I and II.
- While ANP increased during dobutamine infusion, ET-1 concentrations decreased across all groups, suggesting ET-1 does not play a pathophysiologic role during ischemia.
Conclusions:
- Plasma ET-1 and ANP concentrations may serve as predictors of significant coronary artery disease in patients with suspected ischemic heart disease.
- ET-1 does not appear to have a pathophysiologic role during acute ischemic events.
- These biomarkers warrant further investigation for their diagnostic utility in ischemic heart disease.
Abstract:
The aim of this study was to test the hypothesis that plasma endothelin-1 (ET-1) and atrial natriuretic peptide (ANP) concentrations in patients with ischemic heart disease are related either to myocardial ischemia or left ventricular (LV) dysfunction during dobutamine stress echocardiography. Plasma concentrations of ET-1 and ANP were measured in three patient groups. Group I (n = 21) patients had normal stress echocardiography and a resting LV ejection fraction (LVEF) of 40% or more. Group II (n = 32) had positive stress echocardiography and a resting LVEF of more than 40%. Group III (n = 18) had positive stress echocardiography with a resting LVEF of less than 40%. All three groups were subjected to thallium 201 scintigraphy and coronary angiography studies. The resting LV end-diastolic pressure was significantly higher in groups II and III than in Group I. The LVEF decreased significantly in group III compared to groups I and II. In the resting state, groups II and III had higher ET-1 concentrations than Group I (p = 0.021 and p = 0.039, respectively). The plasma ANP concentration was higher in group III than in groups I and II (p = 0.005 and p = 0.054, respectively). During peak dobutamine infusion, the ET-1 concentration dropped 8.7% from the baseline in group I, 10.2% in group II, and 10.5% in group III. The ANP concentrations were increased in all three groups but only the increase in Group II reached statistical significance. In conclusion, in patients with suspected ischemic heart disease, the concentrations of ET-1 and ANP may predict significant anatomic and functional coronary artery disease. However, ET-1 does not play a pathophysiologic role during an ischemic attack.