Galatius S, Wroblewski H, Sørensen V B, Bie P, Parving H H, Kastrup J
The Heart Center, The Rigshospital, University of Copenhagen, Denmark.
Am Heart J. 1999 Mar;137(3):549-54. doi: 10.1016/s0002-8703(99)70505-3.
Congestive heart failure (CHF) and heart transplantation (HTX) are characterized by endothelial dysfunction as indicated by elevation of markers of endothelial function, including endothelin and von Willebrand factor (vWF). However, previous studies included both patients with idiopathic dilated cardiomyopathy and ischemic heart disease; the latter condition shows endothelial dysfunction, per se. The 2 endothelial factors have different origin and may provide different information about endothelial dysfunction in CHF and after HTX caused by idiopathic dilated cardiomyopathy.
We investigated plasma endothelin and vWF, the relation between these 2 factors, and determinants of endothelin and vWF plasma levels in 32 healthy controls, 25 patients with CHF, and 22 patients who had HTX; both conditions were caused by idiopathic dilated cardiomyopathy.
Plasma endothelin was elevated in CHF (6.8 +/- 3.4 pg/mL) and after HTX (6.1 +/- 2.1) compared with healthy controls (4.0 +/- 1.0, P <.0001 for both). VWF was also elevated in CHF (1.6 +/- 0.6 U/mL) and after HTX (2.6 +/- 1.0) compared with healthy controls (1.0 +/- 0.5, P <.0001 for both). VWF was increased after HTX compared with CHF (P <.001), in contrast to similar endothelin levels in CHF and after HTX. Plasma endothelin and vWF correlated in both CHF (r = 0.65, P <.001) and HTX (r = 0.66, P <. 001) but not in controls. In CHF, New York Heart Association functional class was an independent determinant of vWF (P <.0001) and furosemide dose of endothelin (P <.0001). In cardiac transplant recipients, plasma albumin was an independent determinant of vWF (P <.01), and plasma sodium and furosemide dose were independent determinants of endothelin (P <.01).
Plasma endothelin and vWF were directly correlated in both CHF and after HTX caused by idiopathic dilated cardiomyopathy. However, the production of the 2 factors appeared to be stimulated by different mechanisms and provided different information about endothelial function, as indicated by the different determinants and different response to heart transplantation.
充血性心力衰竭（CHF）和心脏移植（HTX）的特征为内皮功能障碍，这可通过内皮功能标志物升高来表明，这些标志物包括内皮素和血管性血友病因子（vWF）。然而，既往研究纳入了特发性扩张型心肌病和缺血性心脏病患者；后者本身就存在内皮功能障碍。这两种内皮因子来源不同，可能会提供关于特发性扩张型心肌病所致CHF及HTX后内皮功能障碍的不同信息。
我们调查了32名健康对照者、25名CHF患者和22名接受HTX患者的血浆内皮素和vWF、这两种因子之间的关系以及内皮素和vWF血浆水平的决定因素；这两种情况均由特发性扩张型心肌病引起。
与健康对照者（4.0±1.0）相比，CHF患者（6.8±3.4 pg/mL）和HTX后患者（6.1±2.1）的血浆内皮素升高（两者P均<.0001）。与健康对照者（1.0±0.5）相比，CHF患者（1.6±0.6 U/mL）和HTX后患者（2.6±1.0）的vWF也升高（两者P均<.0001）。与CHF相比，HTX后vWF升高（P<.001），而CHF和HTX后内皮素水平相似。CHF和HTX患者血浆内皮素和vWF均呈相关性（CHF中r = 0.65，P<.001；HTX中r = 0.66，P<.001），但在对照者中无相关性。在CHF中，纽约心脏协会功能分级是vWF的独立决定因素（P<.0001），而速尿剂量是内皮素的独立决定因素（P<.0001）。在心脏移植受者中，血浆白蛋白是vWF的独立决定因素（P<.01），而血浆钠和速尿剂量是内皮素的独立决定因素（P<.01）。
在特发性扩张型心肌病所致CHF及HTX后，血浆内皮素和vWF均直接相关。然而，这两种因子的产生似乎受不同机制刺激，且如不同的决定因素及对心脏移植的不同反应所示，提供了关于内皮功能的不同信息。
