Hülsmann M, Stanek B, Frey B, Sturm B, Putz D, Kos T, Berger R, Woloszczuk W, Putz D, Kos T, Berger R, Woloszczuk W, Maurer G, Pacher R
Department of Cardiology, University of Vienna, Austria.
J Am Coll Cardiol. 1998 Nov 15;32(6):1695-700. doi: 10.1016/s0735-1097(98)00437-9.
We tested the hypothesis that, in patients with stable heart failure, measuring big endothelin-1 (ET-1) plasma level at rest predicts short-term prognosis better than peak oxygen consumption (VO2max) at exercise.
Cardiopulmonary exercise testing and evaluation of neurohumoral plasma factors are established tools to estimate survival in patients with heart failure. No data, however, exist comparing the prognostic value of both marker categories simultaneously.
Two hundred twenty-six heart failure patients were studied in regard to a combined end point of death and prioritization for urgent cardiac transplantation within 1 year follow-up.
During the study period 149 patients were without cardiac events (group A), 69 patients died or were urgently transplanted (group B) and 8 patients were alive after a nonurgent heart transplant operation. Norepinephrine (p < 0.0001), atrial natriuretic peptide (p < 0.001), big endothelin plasma levels (p < 0.0001 as well as workload, VO2max and achieved percentage of predicted peak oxygen consumption (pVO2max) (all p < 0.0001) differed significantly between groups A and B. In multivariate stepwise regression analysis, however, only big ET-1 plasma concentration (chi2=74.4, p < 0.0001), New York Heart Association function class (chi2=33.9, p < 0.0001), maximal workload (chi2=7.2, p < 0.01, and plasma atrial natriuretic peptide (ANP) concentration (chi2=4.6, p < 0.05) were independently related to outcome. Peak oxygen consumption or pVO2max did not reach statistical significance in this model. Event-free survival rates were significantly lower in patients with a big ET-1 level of 4.3 fmol/ml or more than with lower big ET-1 levels (p < 0.0001).
We conclude that in patients with chronic heart failure who are stable on oral therapy measuring big ET-1 and ANP plasma levels may be a valuable noninvasive adjunct to improve the prognostic accuracy of detecting high risk patients compared with exercise testing alone.
我们检验了这样一个假设，即在稳定型心力衰竭患者中，静息时测量大内皮素-1（ET-1）血浆水平比运动时的峰值耗氧量（VO2max）能更好地预测短期预后。
心肺运动试验和神经体液血浆因子评估是估计心力衰竭患者生存率的既定工具。然而，尚无数据同时比较这两类标志物的预后价值。
对226例心力衰竭患者进行了研究，观察其在1年随访期内的死亡和紧急心脏移植优先级的综合终点。
在研究期间，149例患者无心脏事件（A组），69例患者死亡或接受紧急移植（B组），8例患者在非紧急心脏移植手术后存活。A组和B组之间去甲肾上腺素（p<0.0001）、心房利钠肽（p<0.001）、大内皮素血浆水平（p<0.0001）以及工作量、VO2max和预测峰值耗氧量（pVO2max）的实现百分比（均p<0.0001）存在显著差异。然而，在多变量逐步回归分析中，只有大ET-1血浆浓度（χ2=74.4，p<0.0001）、纽约心脏协会功能分级（χ2=33.9，p<0.0001）、最大工作量（χ2=7.2，p<0.01）和血浆心房利钠肽（ANP）浓度（χ2=4.6，p<0.05）与结局独立相关。在该模型中，峰值耗氧量或pVO2max未达到统计学显著性。大ET-1水平为4.3 fmol/ml或更高的患者的无事件生存率显著低于大ET-1水平较低的患者（p<0.0001）。
我们得出结论，对于口服治疗稳定的慢性心力衰竭患者，测量大ET-1和ANP血浆水平可能是一种有价值的非侵入性辅助手段，与单独的运动试验相比，可提高检测高危患者的预后准确性。
