Document Detail


Relationship between baseline ET-1 plasma levels and outcome in patients with idiopathic pulmonary hypertension treated with bosentan.
MedLine Citation:
PMID:  22265324     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: To address if baseline endothelin-1 (ET-1) plasma levels might predict clinical worsening (CW) in patients with idiopathic pulmonary hypertension (IPAH) treated with bosentan. METHODS: Forty-four consecutive patients with IPAH (WHO classes II-III) were included in this study. After an initial assessment (clinical status, pulmonary hemodynamics, samples for adrenomedullin (ADM), ET-1 and brain natriuretic peptide (BNP) plasma levels), patients were treated with bosentan and followed-up for CW. RESULTS: We observed CW in 24 patients. Actuarial rates of freedom from CW were 74% at 1year, 56% at 2years, and 43% at 3years. Patients with CW had a worse WHO functional class (II/III; no-CW 14/6 vs CW 5/19, p=0.002), six-minute walk-test distance (no-CW 439+94m vs CW 385+82m, p=0.04), mean pulmonary artery pressure (no-CW 47.4+10.6mm Hg vs CW 56+12.6mm Hg, p=0.02) and pulmonary vascular resistance (PVR no-CW 12.5+4.8 WU vs CW 16.4+6.3 WU, p=0.03) than the no-CW group. Moreover ET-1 (no-CW 14.1+4.2pg/ml vs CW 21.3+6.3pg/ml, p=0.0001), ADM (no-CW 14.9+7pg/ml vs CW 21.5+10.4pg/ml p=0.002) and BNP (no-CW 82.8+35.3pg/ml vs CW 115.4+39.6pg/ml, p=0.007) plasma levels were significantly higher in the CW group than in the no-CW group. The multivariate Cox proportional hazards model identified WHO class III (RR 4.6, 95%CI 14.6-1.45), ET-1 plasma levels (RR 1.1, 95%CI 2.05-1.01) and PVR (RR 1.2, 95%CI 1.3-1.03) as independent risk factors for CW. CONCLUSIONS: These data confirm the high rate of CW in patients with IPAH treated with bosentan and document the impact of the endothelin system on CW of these patients.
Authors:
Carmine Dario Vizza; Claudio Letizia; Roberto Badagliacca; Roberto Poscia; Beatrice Pezzuto; Cristina Gambardella; Alfred Nona; Silvia Papa; Serena Marcon; Massimo Mancone; Carlo Iacoboni; Valeria Riccieri; Maurzio Volterrani; Francesco Fedele
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-18
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011. Published by Elsevier Ireland Ltd.
Affiliation:
Dept. Cardiovascular and Respiratory Science, University of Rome, "La Sapienza", Italy.
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