Direct Comparison Between endothelin-1, N-terminal Proatrial Natriuretic Factor, and Brain Natriuretic Peptide as Prognostic Markers of Survival in Congestive Heart Failure

J Card Fail. 2000 Sep;6(3):201-7. doi: 10.1054/jcaf.2000.8833.


Background: Endothelin-1 (ET-1) and cardiac natriuretic peptide plasma concentrations 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-terminal 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 York 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 beginning of the study, and a Cox regression model was used to identify predictors of death. Plasma concentrations of the 3 peptides increased with the severity of heart failure. By univariate analysis, 6 parameters were significantly 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 contributed significantly and independently to risk stratification (chi2 = 53.4 and 12.8; P < .0001 and P < .001, respectively).

Conclusion: In a group of patients in whom the vast majority were administered angiotensin-converting enzyme inhibitor therapy, plasma ET-1 and N-proANF concentrations identify better than several clinical markers a very high-risk group, fairly amenable to heart transplantation or new therapies.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atrial Natriuretic Factor / blood*
  • Belgium / epidemiology
  • Biomarkers / blood
  • Endothelin-1 / blood*
  • Female
  • Follow-Up Studies
  • Heart Failure / blood*
  • Heart Failure / drug therapy
  • Heart Failure / mortality
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Protein Precursors / blood*
  • Survival Analysis
  • Treatment Outcome


  • Biomarkers
  • Endothelin-1
  • Protein Precursors
  • Natriuretic Peptide, Brain
  • Atrial Natriuretic Factor