Direct comparison between endothelin-1, N-terminal proatrial natriuretic factor, and brain natriuretic peptide as prognostic markers of survival in congestive heart failure

Background: Endothelin-1 (ET-1) and cardiac natriuretic peptide plasma conc entrations have prognostic significance in congestive heart failure (CHF). However, their respective prognostic values in this setting have never been directly compared. Methods and Results: We studied the prognostic performances of ET-1, N-term inal proatrial natriuretic factor (N-proANF), and brain natriuretic peptide (BNP) to predict the long-term cardiac mortality in fully treated patients with CHF. Peripheral plasma concentrations of the 3 peptides were measured in 109 patients (left ventricular ejection fraction [LVEF] < 35%) in New Y ork Heart Association (NYHA) functional classes II (n = 65) or III to IV (n = 44). The outcome of the patients was evaluated 3 years after the beginni ng of the study, and a Cox regression model was used to identify predictors of death. Plasma concentrations of the 3 peptides increased with the sever ity of heart failure. By univariate analysis, 6 parameters were significant ly associated with death during follow-up: ET-1 level: NYHA classes III to IV, N-proANF level, BNP level, LVEF, and age (all P < .01). By multivariate analysis, only ET-1 level and, to a lesser extent, N-proANF level contribu ted significantly and independently to risk stratification (chi(2) = 53.4 a nd 12.8; P < .0001 and P < .001, respectively). Conclusion: In a group of patients in whom the vast majority were administe red angiotensin-converting enzyme inhibitor therapy, plasma ET-1 and N-proA NF concentrations identify better than several clinical markers a very high -risk group, fairly amenable to heart transplantation or new therapies.