Li Xiao-Yao, Zhao Shuang, Fan Xiao-Han, Chen Ke-Ping, Hua Wei, Liu Zhi-Min, Xue Xiao-Di, Zhou Bin, Zhang Shu
Arrhythmia 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.
J Geriatr Cardiol. 2020 Jul 28;17(7):427-433. doi: 10.11909/j.issn.1671-5411.2020.07.003.
To investigate whether plasma big endothelin-1 (ET-1) predicts ventricular arrythmias (VAs) and end-stage events in primary prevention implantable cardioverter-defibrillator (ICD) indication patigents.
In total, 207 patients fulfilling the inclusion criteria from Fuwai Hospital between January 2013 and December 2015 were retrospectively analyzed. The cohort was divided into three groups according to baseline plasma big ET-1 tertiles: tertile 1 (< 0.38 pmol/L, = 68), tertile 2 (0.38-0.7 pmol/L, = 69), and tertile 3 (> 0.7 pmol/L, = 70). The primary endpoints were VAs. The secondary endpoints were end-stage events comprising all-cause mortality and heart transplantation.
During a mean follow-up period of 25.6 ± 13.9 months, 38 (18.4%) VAs and 78 (37.7%) end-stage events occurred. Big ET-1 was positively correlated with NYHA class ( = 0.165, = 0.018), serum creatinine concentration (Scr; = 0.147, = 0.034), high-sensitivity C-reactive protein (hs-CRP; = 0.217, = 0.002), Lg NT-pro BNP ( = 0.463, < 0.001), left ventricular end diastolic diameter (LVEDD; = 0.234, = 0.039) and negatively correlated with left ventricular ejection fraction (LVEF; = -0.181, = 0.032). Kaplan-Meier analysis showed that elevated big ET-1 was associated with increased risk of VAs and end-stage events ( < 0.05). In multivariate Cox regression models, big ET-1 was an independent risk factor for VAs (hazard ratio (HR) = 3.477, 95% confidence interval (CI): 1.352-8.940, = 0.010, tertile 2 tertile 1; HR = 4.112, 95% CI: 1.604-10.540, = 0.003, tertile 3 tertile 1) and end-stage events (HR = 2.804, 95% CI: 1.354-5.806, = 0.005, tertile 2 tertile 1; HR = 4.652, 95% CI: 2.288-9.459, < 0.001, tertile 3 tertile 1).
In primary prevention ICD indication patients, plasma big ET-1 levels can predict VAs and end-stage events and may facilitate ICD-implantation risk stratification.
探讨血浆大内皮素-1（ET-1）是否可预测一级预防植入式心律转复除颤器（ICD）适应证患者的室性心律失常（VA）和终末期事件。
回顾性分析2013年1月至2015年12月期间来自阜外医院的207例符合纳入标准的患者。根据基线血浆大ET-1三分位数将队列分为三组：三分位数1（<0.38 pmol/L，n = 68），三分位数2（0.38 - 0.7 pmol/L，n = 69）和三分位数3（>0.7 pmol/L，n = 70）。主要终点为VA。次要终点为包括全因死亡率和心脏移植在内的终末期事件。
在平均随访25.6±13.9个月期间，发生了38例（18.4%）VA和78例（37.7%）终末期事件。大ET-1与纽约心脏协会（NYHA）分级呈正相关（r = 0.165，P = 0.018）、血清肌酐浓度（Scr；r = 0.147，P = 0.034）、高敏C反应蛋白（hs-CRP；r = 0.217，P = 0.002）、Log NT-pro BNP（r = 0.463，P < 0.001）、左心室舒张末期内径（LVEDD；r = 0.234，P = 0.039），与左心室射血分数（LVEF；r = -0.181，P = 0.032）呈负相关。Kaplan-Meier分析显示，升高的大ET-1与VA和终末期事件风险增加相关（P < 0.05）。在多变量Cox回归模型中，大ET-1是VA的独立危险因素（风险比（HR）= 3.477，95%置信区间（CI）：1.352 - 8.940，P = 0.010，三分位数2对比三分位数1；HR = 4.112，95% CI：1.604 - 10.540，P = 0.003，三分位数3对比三分位数1）和终末期事件（HR = 2.804，95% CI：1.354 - 5.806，P = 0.005，三分位数2对比三分位数1；HR = 4.652，95% CI：2.288 - 9.459，P < 0.001，三分位数3对比三分位数1）。
在一级预防ICD适应证患者中，血浆大ET-1水平可预测VA和终末期事件，并可能有助于ICD植入风险分层。
