Plasma Endothelin‐1 in patients with atrial septal defect – the novel diagnostic indicator (RCD code: IV-2B.1)
Background: The study aimed to assess the level of plasma Endothelin-1 (ET-1) in patients before and after transcatheter closure of atrial septal defect (ASD) and to evaluate the usefulness of measuring ET-1 levels for the diagnosis and selection of candidates for ASD closure.
Methods: 21 patients (11 F, 10 M), mean age 40.2 ± 11.9 years with pulmonary artery hypertension were enrolled for an attempt at ASD closure. A group of 19 healthy volunteers, (12 F, 7 M) mean age 39.2 ± 9.15 served as controls. All ASD patients underwent: clinical and echocardiographic study and cardiopulmonary exercise test. ET-1 levels were measured before and after closure. Whole blood was collected from femoral artery and vein and from pulmonary artery during cardiac catheterization.
Results: ET-1 levels at peripheral artery and vein in ASD patients were significantly higher than in the volunteers (p<0.0001). The ASD subjects with highest ET-1 level presented the larger area of right ventricle and right atrium and higher pulmonary artery systolic pressure(p<0.05). The ASD subjects with lower ET-1 level demonstrated longer time of exercise and higher peak oxygen consumption (p<0.05). There was a decrease of ET-1 at peripheral artery (5.549 ± 5.32 vs. 1.92 ± 7.2; p<0.001) and at peripheral vein (4.012 ± 2.342 vs. 2.15 ± 1.15; p<0.001) within 48 hours after ASD closure, as compared to the baseline data. After 6 and 12 months farther drop in ET-1 level was observed.
1. The level of ET-1 in patients with ASD and pulmonary artery hypertension is elevated in compare to healthy subject.
2. The significant reduction of ET-1 level is observed after percutaneous closure of ASD.
3. Elevated level of ET-1 in patients with ASD is associated with right heart enlargement.
4. Measurements of ET-1 may be a supplemental diagnostic tool and may be helpful in establishing indications for defect closure.
Amin Z.: Transcatheter closure of secundum atrial septal defects. Catheter Cardiovasc Interv. 2006 Nov;68(5):778-87. Review..
Dickinson D.F., Arnold R., Wilkinson J.L.: Congenital heart disease among 160 480 liveborn children in Liverpool 1960-1969: implication for surgical treatment. Br. Heart J. 1981, 46, 55-62.
Rigby M.L.: The era of transcatheter closure of atrial septal defects. Heart 1999, 81, 227-228.
Therrien J., Webb D.: Congenital Heart Disease in Adult. In Braunwald E.: Heart Disease: a Textbook of Cardiovascular Medicine. 6th ed. Philadelphia: W.B. Saunders, 2001, 44, 1592-1618.
Gupta A, Kapoor G, Dalvi B.: Transcatheter closure of atrial septal defects. Expert Rev Cardiovasc Ther. 2004 Sep;2(5):713-9. Review.
Ward C.: Secundum atrial septal defect: routine surgical treatment is not of proven benefit. Br. Heart J. 1994, 71, 219-223.
Swartz EN.: Is transcatheter device occlusion as good as open heart surgery for closure of atrial septal defects?. Arch Dis Child. 2004 Jul;89(7):687-8.
Gault J.H., Morrow A.G., Gay W. A., Ross JR. Atrial Septal Defect in Patients over the Age of Forty Years. Clinical and Hemodynamic Studies and the Effects of Operation. Circulation 1968, 37, 261-271.
Brochu M.C., Baril J.F., Dore A. Juneau M., De Guide P, Mercie L.A.: Improvement in Exercise Capacity in Asymptomatic and Mildly Symptomatic Adults After Atrial Septal Defect Percutaneous Closure. Circulation 2002, 106, 1821-1826.
Hocher B., Thone-Reineke C., Bauer C. Raschack M; Neumayer H. H.: The paracrine endothelin system: pathophysiology and implications in clinical medicine. Eur. J. Clin. Chem. Clin. Biochem., 1997, 35, 175-189.
Krämer B.K., Ittner K.P., Beyer M.E. Hoffmeister H.M., Günter A. J. Riegger: Circulatory and myocardial effects of endothelin. J. Mol. Med., 1997, 75, 886-890.
Giaid A., Yanagisava M., Langleben D. Rene P. Michel, Robert Levy, Hani Shennib, Sadao Kimura, Tomoh Masaki, William P. Duguid, and Duncan J. Stewart.: Expression of endothelin-1 in the lungs of patients with pulmonary hypertension. N. Engl. J. Med.. 1993, 328, 1606-1611.
Ito H.: Endothelins and cardiac hypertrophy. Life Sci., 1997, 61, 585-593.
Jia B., Zhang S., Chen Z. Li Z, Li X, Hui W, Ye M.: Plasma endothelin 1 concentration in children with congenital heart defects. Minerva Pediatr. 1998, 50, 99-102.
Tutar H.E., Imamoglu A., Atalay S. Gümüs H, Akar N.: Plasma endothelin-1 levels in patients with left-to-right shunt with or without pulmonary hypertension. Int J Cardiol 1999, 70:57-62.
Bando K., Vijayaraghavan P.; Turrentine M. W.; Sharp T. G.; Ensing G. J.; Sekine Y.; Szekely L.; Morelock R. J.; Brown J. W.: Dynamic changes of Endothelin-1, Nitric Oxide and Cyclic GMP in patients with congenital heart disease. Circulation 1997;96:II; 346-351.
Gorenflo M., Gross P., Bodey A. Schmitz L. (1) ; Brockmeier K. (1) ; Berger F. ; Bein G. (1) ; Lange P. E. ;.: Plasma endothelin-1 in patients with left-to-right shunt. Am Heart J 1995;130:537-42.
Adatia I. Haworth S.G.: Circulating endothelin in children with congenital heart disease. Br Heart J 1993;69:233-236.
Snopek G., Pogorzelska H.:Role of endothelin in pathogenesis of pulmonary hypertension. Med. Sci. Monit., 1998, 4, 383-387.
- There are currently no refbacks.