Shengwen Yang1, Zhimin Liu2, Shangyu Liu1, Ligang Ding1, Keping Chen1, Wei Hua1, Shu Zhang1. 1. 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. 2. 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,. Electronic address: liucory@163.com.
Abstract
BACKGROUND: Serum concentration of big endothelin-1 (ET-1) has prognostic significance in heart failure. However, its prognostic value in cardiac resynchronization therapy (CRT) recipients has not been well-characterized. METHODS: A cohort of 367 consecutive patients who received CRT between January 2010 and December 2015 were enrolled, and categorized into three groups according to baseline big ET-1 tertiles: big ET-1 ≤ 0.34 pmol/L (N = 119), big ET-1 between 0.34-0.56 pmol/L (N = 127) and big ET-1 > 0.56 pmol/L (N = 121). The primary endpoints included mortality rate (all-cause) and heart transplantation. RESULTS: Over a median follow-up of 21 months, 48 (13.08%) patients died, 6 (1.63%) underwent heart transplantation and 100 (27.25%) had heart failure hospitalization (HFH). We found a significant difference in event free survival between the three groups, with high levels of big ET-1 correlating with worse survival (Log-rank test, P < .001). After adjusting for multiple factors in the multivariate model, big ET-1 > 0.56 pmol/L was an independent predictor for primary endpoint event [hazard ratio (HR): 2.005, 95% confidence interval(CI) 1.045-6.2621, P = .040] and HFH (HR = 2.126, 95%CI 1.182-3.827, P = .012). CONCLUSION: Baseline big ET-1 > 0.56 pmol/L was independently associated with higher all-cause mortality and HFH among CRT recipients, and therefore can be added to the marker panel used for stratifying high risk CRT patients for priority treatment.
BACKGROUND: Serum concentration of big endothelin-1 (ET-1) has prognostic significance in heart failure. However, its prognostic value in cardiac resynchronization therapy (CRT) recipients has not been well-characterized. METHODS: A cohort of 367 consecutive patients who received CRT between January 2010 and December 2015 were enrolled, and categorized into three groups according to baseline big ET-1 tertiles: big ET-1 ≤ 0.34 pmol/L (N = 119), big ET-1 between 0.34-0.56 pmol/L (N = 127) and big ET-1 > 0.56 pmol/L (N = 121). The primary endpoints included mortality rate (all-cause) and heart transplantation. RESULTS: Over a median follow-up of 21 months, 48 (13.08%) patients died, 6 (1.63%) underwent heart transplantation and 100 (27.25%) had heart failure hospitalization (HFH). We found a significant difference in event free survival between the three groups, with high levels of big ET-1 correlating with worse survival (Log-rank test, P < .001). After adjusting for multiple factors in the multivariate model, big ET-1 > 0.56 pmol/L was an independent predictor for primary endpoint event [hazard ratio (HR): 2.005, 95% confidence interval(CI) 1.045-6.2621, P = .040] and HFH (HR = 2.126, 95%CI 1.182-3.827, P = .012). CONCLUSION: Baseline big ET-1 > 0.56 pmol/L was independently associated with higher all-cause mortality and HFH among CRT recipients, and therefore can be added to the marker panel used for stratifying high risk CRT patients for priority treatment.