Endothelin and van Willebrand factor as parameters of endothelial functionin idiopathic dilated cardiomyopathy: Different stimuli for release beforeand after heart transplantation?

Background Congestive heart failure (CHF) and heart transplantation (HTX) o re characterized by endothelial dysfunction as indicated by elevation of ma rkers of endothelial function, including endothelin and von Willebrand fact or (vWF). However, previous studies included both patients with idiopathic dilated cardiomyopathy and ischemic heart disease; the latter condition sho ws endothelial dysfunction, per se. The 2 endothelial factors have differen t origin and may provide different information about endothelial dysfunctio n in CHF and after HTX caused by idiopathic dilated cardiomyopathy. Methods We investigated plasma endothelin and vWF, the relation between the se 2 factors, and determinants of endothelin and vWF plasma levels in 32 he althy controls, 25 patients with CHF, and 22 patients who had HTX; both con ditions were caused by idiopathic dilated cardiomyopathy. Results Plasma endothelin was elevated in CHF (6.8 +/- 3.4 pg/ml) and after HTX (6.1 +/- 2.1) compared with healthy controls (4.0 +/- 1.0, P <.0001 fo r both). VWF was also elevated in CI-IF (1.6 +/- 0.6 U/mL) and after HTX (2 .6 +/- 1.0) compared with healthy controls (1.0 +/- 0.5, P <.0001 for both) . VWF was increased after HTX compared with CHF (P <.001), in contrast to s imilar endothelin levels in CHF and after HTX. Plasma endothelin and VWF co rrelated in both CHF (r = 0.65, P <.001) and HTX (r = 0.66, P <.001) but no t in controls. In CHF, New York Heart Association functional class was an i ndependent determinant of vWF (P <.0001) and furosemide dose of endothelin (P <.0001). In cardiac transplant recipients, plasma albumin was an indepen dent determinant of vWF (P <.01), and plasma sodium and furosemide dose wer e independent determinants of endothelin (P <.01). Conclusions Plasma endothelin and vWF were directly correlated in both CHF and after HTX caused by idiopathic dilated cardiomyopathy. However, the pro duction of the 2 factors appeared to be stimulated by different mechanisms and provided different information about endothelial function, as indicated by the different determinants and different response to heart transplantat ion.