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Abstract
SUMMARY AND CONCLUSION
Heart failure is defined as the status of heart damage when, despite sufficient filling of the ventricles, the cardiac output decreases and the heart is not able to maintain the metabolic needs of tissues. It constitutes a public-health problem of increasing importance.
Plasma concentrations of endothelin-1, the 21 amino acids peptide, are elevated in patients with heart failure. It has been demonstrated that the sensitivity and specificity of plasma ET as a predictor of heart failure are high, thus circulating endothelin may serves as an important marker of heart failure.
Inhibition of the endothelin function is associated with an improvement of haemodynamic conditions; so endothelin-receptor antagonists or endothelin converting enzyme inhibitors may constitute a potentially important class of agents for the treatment of this disease.
This study was carried out in Clinical and Chemical Pathology Department, Faculty of Medicine, Zagazig University Hospital.
The study included 40 subjects; they were classified into 30 patients suffering from left ventricular dysfunction whose ejection fraction ≤ 50% with or without symptoms of heart failure and 10 apparently healthy individuals served as control group. The patients were selected from Cardiology Department in Zagazig University Hospital.
All the members of this study were subjected to the following:
1. Full history taking.
2. Complete clinical examination.
3. Cardiac investigations including:
a- Electrocardiography (ECG).
b- Doppler echocardiography.
4. Routine laboratory investigations as follows:
• Complete blood count
• Na+ & K+ measurement.
• Liver function tests.
• Kidney function tests.
• Serum lipids.
5. Specific laboratory investigations in the form of measurement of plasma endothelin-1 by EIA technique after extraction procedure.
This work was carried out to measure endothelin-1 level in the plasma of the patients of heart failure and to analyze the correlation between its level and clinical, laboratory and echocardiographic parameters in a trial to assess its role in the diagnosis of the disease.
In this study, the results were statistically analyzed and revealed the following:
• All the members of patients group were suffering from dyspnea but not all were suffering from L.L. oedema, n.v. congestion or basal crepitations.
• The underlying aetiology of heart failure in patients group varied between valvular and cardiomyopathy (either dilated or ischaemic).
• EDD, ESD and LA size were significantly higher in patients group than the value of the control group. While the EF% was significantly lower in patients group than the control group.
• Serum Na+ level and hemoglobin concentration were highly significantly lower in patients group when compared to the control group.
• There was a significant increase in K+ level in patients group compared to the control group.
• There were no statistically significant differences between the two groups in the levels of serum urea, serum creatinine or serum lipids.
• The plasma levels of endothelin-1 were highly significantly higher in patients group when compared to the control group.
• There were highly significant positive correlations between plasma levels of endothelin-1 and each of EDD, ESD and LA size in patients group.
• Plasma levels of endothelin-1 and each of EF% and hemoglobin concentration of patients group showed highly significant inversed correlations.
• There was significant positive correlation between plasma levels of endothelin-1 and time of evolution of patients, and a significant inversed correlation between plasma levels of endothelin-1 and serum Na+ of the patients.
• There were no statistically significant correlations between the plasma levels of endothelin-1 of the patients and each of the age of patient, serum K+ , serum urea and creatinine and serum lipids.
• Plasma ET-1 levels in patients of CHF showed no differences with relation to aetiology of CHF, sex, smoking and history of hypertension and DM.
Conclusion:
A high plasma level of endothelin-1 represents a highly sensitive method for the diagnosis of chronic heart failure, whereas the normal values exclude this syndrome. Plasma endothelin-1 may be used as a severity marker for heart failure.