Prognostic value of plasma big endothelin-1 in left ventricular non-compaction cardiomyopathy

Fan, Peng; Zhang, Ying; Lu, Yiting; Yang, Kun; Lu, Peipei; Zhang, Qiong-Yu; Luo, Fang; Lin, Ya-Hui; Zhou, Xin; Tian, Tao

doi:10.1136/heartjnl-2020-317059

Cited by 8 publications

(6 citation statements)

References 31 publications

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“…It has predictive value in patients with chronic heart failure ( 25 ), and its predictive value is not inferior to those of hemodynamic monitoring indicators ( 26 ). In patients with arrhythmia and cardiomyopathy, high big ET-1 level has a certain predictive value for death, malignant arrhythmia, heart transplantation, and other adverse events ( 27 – 30 ).…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Plasma Big Endothelin-1 in Adverse Events of Patients With Coronary Artery Restenosis and Diabetes Mellitus: Beyond Traditional and Angiographic Risk Factors

Tian²,

Wang³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPatients with diabetes are a high-risk group for coronary in-stent restenosis (ISR), so it would be valuable to identify biomarkers to predict their prognosis. The plasma big endothelin-1 (big ET-1) level is closely related to cardiovascular adverse events; however, for patients with ISR and diabetes who undergo percutaneous coronary intervention (PCI), whether big ET-1 is independently correlated with prognosis is still uncertain.MethodsPatients with drug-eluting stent (DES) restenosis who underwent successful re-PCI from January 2017 to December 2018 at the Chinese Academy of Medical Sciences Fuwai Hospital were enrolled and followed up for 3 years. The patients were divided into the tertiles of baseline big ET-1. The primary end points were major adverse cardiovascular events (MACEs): cardiac death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), and stroke. A Cox multivariate proportional hazard model and the C-statistic were used to evaluate the potential predictive value of big ET-1 beyond traditional and angiographic risk factors.ResultsA total of 1,574 patients with ISR were included in this study, of whom 795 were diabetic. In patients with ISR and diabetes, after an average follow-up of 2.96 ± 0.56 years, with the first tertile of big ET-1 as a reference, the hazard ratio [HR] (95% CI) of MACEs after adjustment for traditional and angiographic risk factors was 1.24 (0.51–3.05) for the second tertile and 2.60 (1.16–5.81) for the third. Big ET-1 improved the predictive value for MACEs over traditional risk factors (C-statistic: 0.64 vs. 0.60, p = 0.03). Big ET-1 was not significantly associated with the risk of MACEs in patients without diabetes.ConclusionIncreased plasma big ET-1 was associated with a higher risk of adverse cardiovascular prognosis independent of traditional and angiographic risk factors, and therefore, it might be used as a predictive biomarker, in patients with ISR and diabetes.

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Section: Discussionmentioning

confidence: 99%

Predictive Value of Plasma Big Endothelin-1 in Adverse Events of Patients With Coronary Artery Restenosis and Diabetes Mellitus: Beyond Traditional and Angiographic Risk Factors

Tian²,

Wang³

et al. 2022

Front. Cardiovasc. Med.

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“…Except for the potential etiological role of big ET-1 in CAE, this biomarker has been found to be a poor prognosis factor in many cardiovascular diseases including atrial fibrillation, acute myocardial infarction, and left ventricular non-compaction cardiomyopathy (8)(9)(10). Moreover, ET-1 is a key player in endothelial dysfunction and is associated with systemic inflammation (26).…”

Section: Discussionmentioning

confidence: 99%

“…It has the same biological importance as ET-1, a higher concentration, and longer half-life in the peripheral blood (7). Previous studies have identified high levels of big ET-1 as a risk factor for poor prognosis in cardiovascular diseases including atrial fibrillation, acute myocardial infarction, and left ventricular non-compaction cardiomyopathy (8)(9)(10). It has also been reported as a biomarker for predicting the presence of coronary artery ectasia (11).…”

Section: Introductionmentioning

confidence: 99%

Plasma Big Endothelin-1 Level Predicted 5-Year Major Adverse Cardiovascular Events in Patients With Coronary Artery Ectasia

Cai

Wang

Yuan

et al. 2021

Front. Cardiovasc. Med.

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Background: Coronary artery ectasia (CAE) is found in about 1% of coronary angiography and is associated with poor clinical outcomes. The prognostic value of plasma big Endothelin-1 (ET-1) in CAE remains unknown.Methods: Patients with angiographically confirmed CAE from 2009 to 2015, who had big ET-1 data available were included. The primary outcome was 5-year major adverse cardiovascular events (MACE), defined as a component of cardiovascular death and non-fatal myocardial infarction (MI). Patients were divided into high or low big ET-1 groups using a cut-off value of 0.58 pmol/L, according to the receiver operating characteristic curve. Kaplan-Meier method, propensity score method, and Cox regression were used to assess the clinical outcomes in the 2 groups.Results: A total of 992 patients were included, with 260 in the high big ET-1 group and 732 in the low big ET-1 group. At 5-year follow-up, 57 MACEs were observed. Kaplan-Meier analysis and univariable Cox regression showed that patients with high big ET-1 levels were at increased risk of MACE (9.87 vs. 4.50%; HR 2.23, 95% CI 1.32–3.78, P = 0.003), cardiovascular death (4.01 vs. 1.69%; HR 2.37, 95% CI 1.02–5.48, P = 0.044), and non-fatal MI (6.09 vs. 2.84%; HR 2.17, 95% CI 1.11–4.24, P = 0.023). A higher risk of MACE in the high big ET-1 group was consistent in the propensity score matched cohort and propensity score weighted analysis. In multivariable analysis, a high plasma big ET-1 level was still an independent predictor of MACE (HR 1.82, 95% CI 1.02–3.25, P = 0.043). A combination of high plasma big ET-1 concentrate and diffuse dilation, when used to predict 5-year MACE risk, yielded a C-statistic of 0.67 (95% CI 0.59–0.74).Conclusion: Among patients with CAE, high plasma big ET-1 level was associated with increased risk of MACE, a finding that could improve risk stratification.

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“…All the Virchow's triad factors-sluggish blood flow in deep intertrabecular recesses, local myocardial injury, and hypercoagulability/stasis of flow-which contribute to formation of LV thrombus, are present in NCCM, which can also be associated with a hypercoagulability state due to overexpression of factor VIII and endothelin-1. 50 In the current literature, two large studies have highlighted a direct association between NCCM and juvenile 'cryptogenic' stroke: 12-14% patients with NCCM and no other concomitant comorbidities or risk factors (i.e. PFO) experienced an undetermined thromboembolic event, confirming that NCCM may carry a cardioembolic risk per se.…”

Section: Noncompaction Cardiomyopathy Per Sementioning

confidence: 92%

“…All the Virchow's triad factors—sluggish blood flow in deep intertrabecular recesses, local myocardial injury, and hypercoagulability/stasis of flow—which contribute to formation of LV thrombus, are present in NCCM, which can also be associated with a hypercoagulability state due to overexpression of factor VIII and endothelin‐1. 50 …”

Section: Thromboembolic Risk In Noncompaction Cardiomyopathymentioning

confidence: 99%

A proposed strategy for anticoagulation therapy in noncompaction cardiomyopathy

et al. 2021

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Noncompaction cardiomyopathy (NCCM) is a rare condition characterized by prominent trabeculae, deep intertrabecular recesses, and a left ventricular myocardium with a two-layered structure, characterized by a spongy endocardial layer and a thinner and compacted epicardial one. NCCM can be isolated or associated with other congenital heart diseases and complex syndromes involving neuromuscular disorders and facial dysmorphisms. To date, more than 40 genes coding for sarcomeric, cytoskeletal, ion channels, and desmosomal proteins have been identified. Clinical presentation is also highly variable, ranging from no symptoms to end-stage heart failure (HF), lethal arrhythmias, sudden cardiac death, or thromboembolic events. In particular, the prevalence of thromboembolism in NCCM patients appears to be higher than that of a similar, age-matched population without NCCM. Thromboembolism has a multifactorial aetiology, which is linked to genetic, as well as traditional cardiovascular risk factors. In previous studies, atrial fibrillation (AF) was observed in approximately 25-30% of adult NCCM patients and embolism had a cardiac source in ~63-69% of cases; therefore, AF represents a strong predictor of adverse events, especially if associated to HF and neuromuscular disorders. Left ventricular dysfunction is another risk factor for thromboembolism, as a result of blood stagnation and local myocardial injury. Moreover, it is not completely clarified if the presence of deep intertrabecular recesses causing stagnant blood flow can constitute per se a thrombogenic substrate even in absence of ventricular dysfunction. For the clinical management of NCCM patients, an appropriate stratification of the thromboembolic risk is of utmost importance for a timely initiation of anticoagulant therapy. The aim of the present study is to review the available literature on NCCM with particular attention on thromboembolic risk stratification and prevention and the current evidence for oral anticoagulation therapy. The use of direct oral anticoagulants vs. vitamin K antagonists is also discussed with important implications for patient treatment and prognosis.

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Prognostic value of plasma big endothelin-1 in left ventricular non-compaction cardiomyopathy

Cited by 8 publications

References 31 publications

Predictive Value of Plasma Big Endothelin-1 in Adverse Events of Patients With Coronary Artery Restenosis and Diabetes Mellitus: Beyond Traditional and Angiographic Risk Factors

Predictive Value of Plasma Big Endothelin-1 in Adverse Events of Patients With Coronary Artery Restenosis and Diabetes Mellitus: Beyond Traditional and Angiographic Risk Factors

Plasma Big Endothelin-1 Level Predicted 5-Year Major Adverse Cardiovascular Events in Patients With Coronary Artery Ectasia

A proposed strategy for anticoagulation therapy in noncompaction cardiomyopathy

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