Author + information
- Wang Yilu1,
- Yubao Zou2,3,4,
- Xiaoliang Luo2,3,4,
- Lianming Kang2,3,4,
- Dong Wang2,3,4,
- Guixin Wu6,
- Hu Wang2,3,
- Rutai Hui2,3,4,5,
- Jizheng Wang2,3,
- Yida Tang2,3,4 and
- Lei Song2,3,4,5
- 1Department of ICU, China Meitan General Hospital, Beijing, China
- 2State Key Laboratory of Cardiovascular Diseases
- 3National Center for Cardiovascular Disease
- 4Department of Cardiology, Fuwai Hospital
- 5Hypertension Center, Fuwai Hospital
- 6Chinese Academy of Medical Sciences and Peking Union Medical College
The clinical expression of hypertrophic cardiomyopathy (HCM) is variable and largely unpredictable. Big endothelin-1 (ET-1) is the precursor of endothelin-1, which induce cardiomyocyty hypertrophy and intracellular myofibrillar disorganization. The purpose of this study is to observe the relationship between ET-1 and the prognosis of HCM patients.
A total of 245 consecutive patients with HCM were enrolled from 1999 to 2011 and partitioned to quartiles according to their plasma big endothelin-1 levels. The following clinical variables were recorded: medical history, symptoms, and alcohol intake, and smoking habit, current medications for coronary heart disease, hyperlipidemia, and diabetes. All patients underwent a complete cardiac evaluation, including physical examination, 12-lead electrocardiogram, M-mode, 2-dimensional and Doppler echocardiogram. At the entry and during follow up, the primary events were all-cause mortality, including cardiovascular death (SCD, heart failure-related death and fatal stroke) and non-cardiovascular deaths.
At baseline, big endothelin-1 was positively correlated with N-terminal B-type natriuretic peptide (r = 0.291, p < 0.001), late gadolinium enhancement on magnetic resonance imaging (r = 0.222, p = 0.016) and the presence of NYHA class III/IV (r = 0.192, p = 0.003). During a follow-up of 5.1±3.0 years, big endothelin-1 level was positively associated with the risks of all-cause mortality, cardiovascular death, heart failure-related death and progression to heart failure. After adjusting for multiple factors related to survival and cardiac function, the significance remained in the association of big endothelin-1 with the risk of all-cause mortality (hazard ratio (HR) = 1.72, 95% confidence interval (CI) 1.11-2.67, p=0.016) heart failure-related death (HR = 1.86, 95%CI 1.08-3.19, p=0.025) and progression to heart failure (HR = 1.48, 95%CI 1.01-2.16, p=0.043).
Our study showed that increased plasma big endothelin-1 was associated with poor prognosis in patients with HCM. The therapeutic effect of ET-1 blockers should be evaluated in HCM patients.