Hemodynamic and Clinical Correlates of Endothelin-1 in Chronic Thromboembolic Pulmonary Hypertension

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概要

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• Background In non-thromboembolic pulmonary hypertension, endothelin (ET)-1 levels are increased and correlate with the hemodynamic severity of the disease. Whether such correlations exist in chronic thromboembolic pulmonary hypertension (CTEPH) is unknown, nor whether ET-1 levels correlate with hemodynamic outcome after pulmonary endarterectomy (PEA). Methods and Results ET-1 levels were determined by ELISA. ET-levels were increased in 35 CTEPH patients (1.62±0.21pg/ml) compared with healthy controls (n=11: 0.75±0.06pg/ml, p<0.02). ET-1 levels correlated (all p<0.0001) with mean pulmonary artery pressure (mPAP) (r=0.70), cardiac index (r=-0.76), total pulmonary resistance (r=0.72), mixed venous oxygen saturation (r=-0.87), and the distance walked in the 6-min walk test (r=-0.59; p<0.005; n=23). Three months after PEA, ET-1 levels had decreased (p<0.002), and were similar between patients with and without residual pulmonary hypertension (p=0.4). Preoperative ET-1 levels, however, were higher in patients with bad postoperative outcome; that is, patients who either died because of persistent pulmonary hypertension or had residual pulmonary hypertension after PEA (2.68±0.48pg/ml, and 1.13±0.15pg/ml, respectively; p<0.002). The levels also correlated with hemodynamic outcome after PEA (mPAP: r=0.67, p<0.0001). By receiver-operator characteristic curve analysis, ET-1>1.77pg/ml detected a bad postoperative outcome with a sensitivity and specificity of 19% and 85%, respectively, and a likelihood ratio of 5.2. Conclusion ET-1 levels in CTEPH closely correlated with the hemodynamic and clinical severity of disease in a large cohort of patients. Preoperative ET-1 levels may be useful for better identification of patients at risk for persistent pulmonary hypertension after PEA.

• 社団法人日本循環器学会の論文
• 2006-07-20

著者

• Meijer Ronald

  Department Of Cardiothoracic Surgery University Of Amsterdam

• Kloek Jaap

  Department Of Cardiothoracic Surgery University Of Amsterdam

• Reesink Herre

  Department of Pulmonology, University of Amsterdam

• Lutter Rene

  Department of Laboratory of Experimental Immunology of the Academic Medical Center, University of Am

• Boomsma Frans

  Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands

• Jansen Henk

  Department of Pulmonology, University of Amsterdam

• Bresser Paul

  Department of Pulmonology, University of Amsterdam

• Lutter Rene

  Department Of Laboratory Of Experimental Immunology Of The Academic Medical Center University Of Ams

• Jansen Henk

  Department Of Pulmonology University Of Amsterdam

• Bresser Paul

  Department Of Pulmonology University Of Amsterdam

• Reesink Herre

  Department Of Pulmonology University Of Amsterdam

• Boomsma Frans

  Department Of Internal Medicine Erasmus Mc Rotterdam The Netherlands

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• Hemodynamic and Clinical Correlates of Endothelin-1 in Chronic Thromboembolic Pulmonary Hypertension

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