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Clinical Investigations in Critical Care |

Prognostic Value of Hemodynamic vs Big Endothelin Measurements During Long-term IV Therapy in Advanced Heart Failure Patients*

Bernhard Frey, MD; Richard Pacher, MD; Gottfried Locker, MD; Anda Bojic, MD; Engelbert Hartter, MD, PhD; Wolfgang Woloszczuk, PhD; Brigitte Stanek, MD
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*From the Departments of Internal Medicine II (Drs. Frey, Pacher, and Stanek), Internal Medicine I (Dr. Locker), and Internal Medicine IV (Dr. Hartter), University of Vienna, Austria; the Ludwig Boltzmann Institute of Cardiosurgical Research (Dr. Bojic), Vienna, Austria; and the Ludwig Boltzmann Institute of Experimental Endocrinology (Dr. Woloszczuk), Vienna, Austria.

Correspondence to: Bernhard Frey, MD, Klinik für Innere Medizin II, Abteilung für Kardiologie, Währinger Gürtel 18–20, A-1090 Vienna, Austria



Chest. 2000;117(6):1713-1719. doi:10.1378/chest.117.6.1713
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Study objective: To compare hemodynamics and plasma big endothelin levels in patients awaiting heart transplantation who are receiving continuous IV therapy, and to establish their respective potency for predicting future cardiac events.

Design: A randomized, prospective trial of ambulatory continuous treatment with IV prostaglandin E1 (PGE1) vs dobutamine. A subanalysis was conducted of all patients who completed 4 weeks of follow-up in regard to treatment effects on hemodynamics and big endothelin plasma levels.

Patients: Thirty-two listed heart transplant candidates who were refractory to oral treatment, 21 patients who were receiving PGE1, and 11 patients receiving dobutamine.

Measurements and results: Hemodynamics and plasma big endothelin levels were measured at baseline and after 4 weeks. The cardiac index increased significantly (PGE1 group, 1.7 ± 0.4 vs 2.5 ± 0.6 L/min/m2; dobutamine group, 1.8 ± 0.3 vs 2.3 ± 0.6 L/min/m2; p < 0.05), whereas the systemic vascular resistance index (SVRI) decreased significantly only in the PGE1 group (3,352 ± 954 vs 2,178 ± 519 dyne · s · cm−5/m2; p < 0.05). The plasma big endothelin level decreased significantly (PGE1 group, 7.6 ± 3.1 vs 4.7 ± 2.6 fmol/mL; dobutamine group, 6.5 ± 3.7 vs 5.0 ± 2.6 fmol/mL; p < 0.01 for the time effect). Plasma big endothelin (β = 0.393;χ 2 = 10.8; p = 0.001) and SVRI (β = 0.003;χ 2 = 6.9; p < 0.01), both measured after 4 weeks of continuous treatment, were the only independent predictors of future outcome.

Conclusion: Continuous treatment over 4 weeks with either PGE1 or dobutamine in patients awaiting heart transplantation yields an improved hemodynamic state accompanied by a reduction of increased big endothelin levels. Plasma big endothelin measured after 4 weeks of continuous therapy provides prognostic information about future outcome.

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