Key result
Endothelin-1 yields high diagnostic accuracy for acute heart failure and outperforms NT-proBNP for in-hospital mortality.
Why the study?
Acute heart failure management is increasingly complex in multimorbid patients, prompting evaluation of the diagnostic and prognostic performance of endothelin-1 compared with established markers.
Does plasma Endothelin-1 (ET-1) improve diagnostic accuracy and short-term mortality prediction compared to NT-proBNP and hs-cTnI in multimorbid acute heart failure patients?
Cohort (n=76)
No
Does plasma Endothelin-1 (ET-1) improve diagnostic accuracy and short-term mortality prediction compared to NT-proBNP and hs-cTnI in multimorbid acute heart failure patients?
Endothelin-1 is an accurate diagnostic and short-term prognostic biomarker for in-hospital and 30-day mortality in acute heart failure patients that remains unaffected by the burden of multimorbidity.
Answers are grounded in this paper and cite their sources.
May aid diagnosis and short-term prognosis in multimorbid AHF; leaves open superiority to NT-proBNP without prospective trials.
The management of acute heart failure (AHF) is becoming increasingly complex, especially in patients with multiple comorbidities. Endothelin-1 (ET-1), a vasoconstrictive peptide, is an important mediator of neurohormonal activation, endothelial dysfunction, and cardiac remodeling—key processes involved in the pathogenesis of AHF. The aim of our study was to evaluate the diagnostic and prognostic performance of ET-1 in multimorbid AHF patients, compared to established markers such as amino terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI). We conducted a single-center prospective study including 76 patients; 54 with AHF and 22 serving as controls. Upon admission, all patients underwent a comprehensive clinical, echocardiographic, and laboratory evaluation, including plasma ET-1 measurement using the enzyme-linked immunosorbent assay (ELISA) method. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis were performed to assess the diagnostic and prognostic performance of ET-1 in comparison to NT-proBNP and hs-cTnI. ET-1 levels were considerably higher in AHF patients than in controls (p = 0.02), with an AUC of 0.954, showing comparable diagnostic accuracy with NT-proBNP (AUC = 0.997), alongside strong correlations with signs of systemic congestion, increased hospital stay, and ventricular dysfunction. ET-1 had the strongest predictive accuracy for in-hospital mortality (AUC = 0.781, p = 0.026), outperforming NT-proBNP and hs-cTnI. For 30-day mortality, ET-1 remained a reliable predictor (AUC = 0.784, p = 0.016). However, as the follow-up period extended to one year, its predictive power declined, confirming ET-1’s prognostic efficacy only for short-term outcomes. Moreover, ET-1 levels were not influenced by the presence of comorbidities, demonstrating its potential as an independent biomarker. Our findings support that ET-1 is a valuable biomarker for both diagnosis and short-term prognosis in the assessment of multimorbid AHF patients.
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Dmour et al. (2025) conducted a cohort in Multimorbid acute heart failure (AHF) (n=76). Plasma endothelin-1 (ET-1) measurement vs. Established cardiac biomarkers (NT-proBNP and hs-cTnI) and non-AHF/stable CHF controls was evaluated on Diagnostic accuracy for acute heart failure and prognostic accuracy for in-hospital mortality (AUC 0.954 (diagnosis); AUC 0.781 (in-hospital mortality), 95% CI 0.911-0.997, p=<0.001). Endothelin-1 demonstrated high diagnostic accuracy for multimorbid acute heart failure (AUC 0.954, p<0.001) and outperformed NT-proBNP for predicting in-hospital mortality (AUC 0.781, p=0.026).