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Cardiovascular Disorders

Identification of Chronic Heart Failure Patients with a High 12-Month Mortality Risk Using Biomarkers Including Plasma C-Terminal Pro-Endothelin-1
Published: Monday, January 17, 2011
Author: Ewa A. Jankowska et al.

by Ewa A. Jankowska, Gerasimos S. Filippatos, Stephan von Haehling, Jana Papassotiriou, Nils G. Morgenthaler, Mariantonietta Cicoira, Joerg C. Schefold, Piotr Rozentryt, Beata Ponikowska, Wolfram Doehner, Waldemar Banasiak, Oliver Hartmann, Joachim Struck, Andreas Bergmann, Stefan D. Anker, Piotr Ponikowski


We hypothesised that assessment of plasma C-terminal pro-endothelin-1 (CT-proET-1), a stable endothelin-1 precursor fragment, is of prognostic value in patients with chronic heart failure (CHF), beyond other prognosticators, including N-terminal pro-B-type natriuretic peptide (NT-proBNP).


We examined 491 patients with systolic CHF (age: 63±11 years, 91% men, New York Heart Association [NYHA] class [I/II/III/IV]: 9%/45%/38%/8%, 69% ischemic etiology). Plasma CT-proET-1 was detected using a chemiluminescence immunoassay.


Increasing CT-proET-1 was a predictor of increased cardiovascular mortality at 12-months of follow-up (standardized hazard ratio 1.42, 95% confidence interval [CI] 1.04–1.95, p?=?0.03) after adjusting for NT-proBNP, left ventricular ejection fraction (LVEF), age, creatinine, NYHA class. In receiver operating characteristic curve analysis, areas under curve for 12-month follow-up were similar for CT-proET-1 and NT-proBNP (p?=?0.40). Both NT-proBNP and CT-proET-1 added prognostic value to a base model that included LVEF, age, creatinine, and NYHA class. Adding CT-proET-1 to the base model had stronger prognostic power (p<0.01) than adding NT-proBNP (p<0.01). Adding CT-proET-1 to NT-proBNP in this model yielded further prognostic information (p?=?0.02).


Plasma CT-proET-1 constitutes a novel predictor of increased 12-month cardiovascular mortality in patients with CHF. High CT-proET-1 together with high NT-proBNP enable to identify patients with CHF and particularly unfavourable outcomes.