Background-Myocardial expression of endothelin-1 (ET-1) and its receptors ET A and ET B is increased in heart failure.However, the role of ET-1 and its signaling pathways in the pathogenesis of myocardial diseases is unclear. Methods and Results-Human ET-1 cDNA was placed downstream of a promoter responsive to a doxycycline (DOX)-regulated transcriptional activator (tTA). This line (ET ϩ ) was bred with one harboring cardiac myocyterestricted expression of tTA (␣MHC-tTA). Myocardial ET-1 peptide levels were significantly increased in binary transgenic (BT, ET ϩ /tTA ϩ ) compared with nonbinary transgenic (NBT, ET ϩ /tTA Ϫ ; ET Ϫ /tTA ϩ ; ET Ϫ /tTA Ϫ ) or DOX-treated BT littermates (40.1Ϯ4.7 versus 2.6Ϯ1.2 fmol/mL, PϽ0.003). BT mice demonstrated progressive mortality between 5 and 11 weeks after DOX withdrawal, associated with left ventricular dilatation and contractile dysfunction (peak ϩdP/dT, 4673Ϯ468 versus 5585Ϯ658 mm Hg/s, PϽ0.05). An interstitial inflammatory infiltrate, including macrophages and T lymphocytes, was evident in the myocardium of BT mice, associated with sequential increases in nuclear factor-B translocation and expression of tumor necrosis factor-␣, interferon-␥, interleukin-1 and interleukin-6. Significant prolongation of survival was observed with the combined ET A /ET B antagonist LU420627 (nϭ8, PϽ0.05) in BT mice but not the ET A -selective antagonist LU135252 (nϭ5, Pϭ0.9), consistent with an important role for ET B in this model. Conclusions-These are the first data to demonstrate that cardiac overexpression of ET-1 is sufficient to cause increased expression of inflammatory cytokines and an inflammatory cardiomyopathy leading to heart failure and death.