PLASMA BIG ENDOTHELIN-1 CONCENTRATIONS IN CONGESTIVE-HEART-FAILURE PATIENTS WITH OR WITHOUT SYSTEMIC HYPERTENSION

Plasma endothelin concentrations were evaluated in 53 chronic, congest ive heart failure (CHF) patients with or without history of systemic h ypertension, as well as in 9 with hypertension only and in 22 healthy control subjects. Plasma renin, aldosterone and atrial natriuretic pep tide, as well as clinical and hemodynamic data were determined. In pat ients with CHF, big endothelin-1 was, independent of hypertension hist ory, significantly greater than in hypertensive patients with normal c ardiac function and in control subjects (both p < 0.0001). Patients wi th severe CHF had significantly greater big endothelin-1 values than d id those with moderate CHF. During 12-month follow-up, 11 patients wit h CHF underwent heart transplantation, and 9 died; these patients had significantly greater bid endothelin-1 concentrations than did the 33 clinically stable patients (p < 0.001). Big endothelin-1 and atrial na triuretic peptide correlated with right atrial pressure, pulmonary cap illary wedge pressure, left ventricular ejection fraction, effort capa city and severity of CHF (New York Heart Association functional class) .