Clinical Significance of Acute-Phase Endothelin-1 in Acute Myocardial Infarction Patients Treated With Direct Coronary Angioplasty

Abstract

ndothelins (ET) are 21-amino-acid peptides produced by the endothelium and which play important roles in cardiovascular physiology and pathophysiology. 1 The most important ET produced by the endothelium is ET-1, which has an important role in the vasoconstriction of the peripheral arterial system and also of the coronary vascular bed. 2 Elevated plasma concentrations of ET have been observed in patients suffering from diverse cardiovascular diseases, such as congestive heart failure, 3-5 pulmonary hypertension 6 and angina pectoris. [7][8][9] In patients with acute myocardial infarction (AMI) particularly, the cardiac ET system is markedly activated 10,11 and plasma concentrations of ET-1 are elevated. 12 Little is known, however, about the relationship between plasma ET-1 concentrations, mortality and left ventricular (LV) systolic function in human AMI subjects.The object of the present study was to determine whether clinical prognosis after AMI may be predicted from acutephase plasma ET-1 concentrations, and to assess whether there might be any relationship between plasma ET-1 concentrations and LV systolic function. Methods Patient PopulationThe study population comprised 110 consecutive patients (79 males, 31 females; 68±11 years, range 40-93) presenting with a first AMI, admitted and enrolled between March 2003 and June 2004. Diagnosis of AMI was done according to the following criteria: (1) complaint of chest pain and/or discomfort; (2) electrocardiographic ST segment elevation of ≥0.1 mV in 2 or more limb leads, or ≥0.2 mV in 2 or more precordial leads, or new left bundlebranch block; and (3) elevation of total serum creatine kinase (CK) more than twice the upper limit of the normal range. We excluded patients with renal failure on admission (serum creatinine >2.5 mg/dl), patients with old myocardial infarction (MI), patients who reached the institution >6 h after onset, and patients who died <24 h after onset (ie, at the time of blood sampling). We diagnosed anterior MI in 54 patients. Subjects were divided into 2 groups according to the median plasma ET-1 concentration: <2.9 pg/ml (L group, n=55) and ≥2.9 pg/ml (H group, n=55). We distinguished between angina pectoris episodes <24 h before the onset of AMI from general angina pectoris, to take into account ischemic pre-conditioning. Treatment StrategyFollowing oral administration of 200 mg of aspirin and 200 mg of ticlopidine, all patients successfully underwent direct percutaneous coronary intervention (PCI) within 8 h of the onset of symptoms. In 18 patients, conventional plain

<b>The Etiology of &lsquo;Smoker&rsquo;s Paradox&rsquo; in Acute Myocardial Infarction With Special Emphasis on the Association With Inflammation</b>

“…We have also previously shown that females have a significantly higher mortality. 25) By multivariate analysis, however, female gender was not an independent predictor of cardiac mortality. Therefore, we concluded the gender difference between smokers and nonsmokers in this study did not influence survival advantage.…”

Endothelin-1 levels in chronic congestive heart failure

“…In acute myocardial infarction, endothelin-1 levels are increased but are not correlated with HANP levels [17]. BNP acts as an emergency hormone that assists atrial natriuretic peptide(ANP) to regulate blood pressure and body fl uid volume.…”

N-Terminal ProBNP Levels Can Predict Cardiac Failure After Cardiac Surgery

“…23 Comparison with the BNP assay suggests that NT-proBNP could play an additional role in the evaluation of patients with LV systolic dysfunction. 18 The number of patients for whom inotropic agents were required was significantly lower in the group with the low NT-proBNP level than in the group with the high NTproBNP level (p<0.05). The mean duration of inotropic agent usage was 0.46±1.13 h in Group A and 5.92±6.40 h in Group B.…”

“…NT-proBNP levels are reported to be significantly related to LVEF values and increased in patients with LV dysfunction. 18 Plasma NTproBNP is a useful marker for recovery after a high-risk CABG procedure, and conversely significantly correlated with LVEF, and it increases as the LVEF declines. 19,20 In our study we found the LVEF value was statistically significantly higher in Group A than in Group B.…”