VALUE OF CARDIOPULMONARY EXERCISE TESTING AND BIG ENDOTHELIN PLASMA-LEVELS TO PREDICT SHORT-TERM PROGNOSIS OF PATIENTS WITH CHRONIC HEART-FAILURE

Objectives. We tested the hypothesis that, in patients with stable hea rt failure, measuring big endothelin-1 (ET-1) plasma level at rest pre dicts short-term prognosis better than peak oxygen consumption (Vo(2)m ax) at exercise. Background. Cardiopulmonary exercise testing and eval uation of neurohumoral plasma factors are established tools to estimat e survival in patients with heart failure. No data, however, exist com paring the prognostic value of both marker categories simultaneously. Methods. Two hundred twenty-six heart failure patients were studied in regard to a combined end point of death and prioritization for urgent cardiac transplantation within 1 year follow-up. Results. During the study period 149 patients were without cardiac events (group A), 69 pa tients died or were urgently transplanted (group B) and 8 patients wer e alive after a nonurgent heart transplant operation. Norepinephrine ( p < 0.0001), atrial natriuretic peptide (p < 0.001), big endothelin pl asma levels (p < 0.0001 as well as workload, Vo(2)max and achieved per centage of predicted peak oxygen consumption (pVo(2)max) (all p < 0.00 01) differed significantly between groups A and B. In multivariate ste pwise regression analysis, however, only big ET-1 plasma concentration (x2 = 74.4, p < 0.0001), New York Heart Association function class (x 2 = 33.9, p < 0.0001), maximal workload (x2 = 7.2, p < 0.01, and plasm a atrial natriuretic peptide (ANP) concentration (x2 = 4.6, p < 0.05) were independently related to outcome. Peak oxygen consumption or pVo( 2)max did not reach statistical significance in this model. Event-free survival rates were significantly lower in patients with a big ET-1 l evel of 4.3 fmol/ml or more than with lower big ET-1 levels (p < 0.000 1). Conclusion. We conclude that in patients with chronic heart failur e who are stable on oral therapy measuring big ET-1 and ANP plasma lev els may be a valuable noninvasive adjunct to improve the prognostic ac curacy of detecting high risk patients compared with exercise testing alone. (J Am Coil Cardiol 1998;32:1695-700) (C) 1998 by the American C ollege of Cardiology.