Dmour Bianca-Ana, Badescu Minerva Codruta, Tuchiluș Cristina, Cianga Corina Maria, Constantinescu Daniela, Dima Nicoleta, Duca Ștefania Teodora, Dmour Awad, Costache Alexandru Dan, Cepoi Maria-Ruxandra, Crișan Adrian, Leancă Sabina Andreea, Loghin Cătălin, Șerban Ionela-Lăcrămioara, Costache-Enache Irina Iuliana
Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania.
Cardiology Clinic, "St. Spiridon" County Emergency Hospital, 700111 Iasi, Romania.
Life (Basel). 2025 Apr 9;15(4):628. doi: 10.3390/life15040628.
The management of acute heart failure (AHF) is becoming increasingly complex, especially in patients with multiple comorbidities. Endothelin-1 (ET-1), a vasoconstrictive peptide, is an important mediator of neurohormonal activation, endothelial dysfunction, and cardiac remodeling-key processes involved in the pathogenesis of AHF. The aim of our study was to evaluate the diagnostic and prognostic performance of ET-1 in multimorbid AHF patients, compared to established markers such as amino terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI). We conducted a single-center prospective study including 76 patients; 54 with AHF and 22 serving as controls. Upon admission, all patients underwent a comprehensive clinical, echocardiographic, and laboratory evaluation, including plasma ET-1 measurement using the enzyme-linked immunosorbent assay (ELISA) method. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis were performed to assess the diagnostic and prognostic performance of ET-1 in comparison to NT-proBNP and hs-cTnI. ET-1 levels were considerably higher in AHF patients than in controls ( = 0.02), with an AUC of 0.954, showing comparable diagnostic accuracy with NT-proBNP (AUC = 0.997), alongside strong correlations with signs of systemic congestion, increased hospital stay, and ventricular dysfunction. ET-1 had the strongest predictive accuracy for in-hospital mortality (AUC = 0.781, = 0.026), outperforming NT-proBNP and hs-cTnI. For 30-day mortality, ET-1 remained a reliable predictor (AUC = 0.784, = 0.016). However, as the follow-up period extended to one year, its predictive power declined, confirming ET-1's prognostic efficacy only for short-term outcomes. Moreover, ET-1 levels were not influenced by the presence of comorbidities, demonstrating its potential as an independent biomarker. Our findings support that ET-1 is a valuable biomarker for both diagnosis and short-term prognosis in the assessment of multimorbid AHF patients.
急性心力衰竭（AHF）的管理正变得日益复杂，尤其是在患有多种合并症的患者中。内皮素-1（ET-1）是一种血管收缩肽，是神经激素激活、内皮功能障碍和心脏重塑（这些是AHF发病机制中的关键过程）的重要介质。我们研究的目的是评估与氨基末端前B型利钠肽（NT-proBNP）和高敏心肌肌钙蛋白I（hs-cTnI）等既定标志物相比，ET-1在患有多种合并症的AHF患者中的诊断和预后性能。我们进行了一项单中心前瞻性研究，纳入了76名患者；其中54名患有AHF，22名作为对照。入院时，所有患者都接受了全面的临床、超声心动图和实验室评估，包括使用酶联免疫吸附测定（ELISA）方法测量血浆ET-1。进行受试者工作特征（ROC）曲线和曲线下面积（AUC）分析，以评估与NT-proBNP和hs-cTnI相比ET-1的诊断和预后性能。AHF患者的ET-1水平显著高于对照组（P = 0.02），AUC为0.954，显示出与NT-proBNP相当的诊断准确性（AUC = 0.997），同时与全身充血体征、住院时间延长和心室功能障碍密切相关。ET-1对院内死亡率的预测准确性最强（AUC = 0.781，P = 0.026），优于NT-proBNP和hs-cTnI。对于30天死亡率，ET-1仍然是一个可靠的预测指标（AUC = 0.784，P = 0.016）。然而，随着随访期延长至一年，其预测能力下降，这证实了ET-1仅对短期预后具有预后疗效。此外，ET-1水平不受合并症存在的影响，表明其作为独立生物标志物的潜力。我们的研究结果支持，在评估患有多种合并症的AHF患者时，ET-1是诊断和短期预后的有价值生物标志物。
