Hemodynamic and clinical correlates of endothelin-1 in chronic thromboembolic pulmonary hypertension

Circ J. 2006 Aug;70(8):1058-63. doi: 10.1253/circj.70.1058.


Background: In non-thromboembolic pulmonary hypertension, endothelin (ET)-1 levels are increased and correlate with the hemodynamic severity of the disease. Whether such correlations exist in chronic thromboembolic pulmonary hypertension (CTEPH) is unknown, nor whether ET-1 levels correlate with hemodynamic outcome after pulmonary endarterectomy (PEA).

Methods and results: ET-1 levels were determined by ELISA. ET-levels were increased in 35 CTEPH patients (1.62+/-0.21 pg/ml) compared with healthy controls (n=11: 0.75+/-0.06 pg/ml, p<0.02). ET-1 levels correlated (all p<0.0001) with mean pulmonary artery pressure (mPAP) (r=0.70), cardiac index (r=-0.76), total pulmonary resistance (r=0.72), mixed venous oxygen saturation (r=-0.87), and the distance walked in the 6-min walk test (r=-0.59; p<0.005; n=23). Three months after PEA, ET-1 levels had decreased (p<0.002), and were similar between patients with and without residual pulmonary hypertension (p=0.4). Preoperative ET-1 levels, however, were higher in patients with bad postoperative outcome; that is, patients who either died because of persistent pulmonary hypertension or had residual pulmonary hypertension after PEA (2.68+/-0.48 pg/ml, and 1.13+/-0.15 pg/ml, respectively; p<0.002). The levels also correlated with hemodynamic outcome after PEA (mPAP: r=0.67, p<0.0001). By receiver-operator characteristic curve analysis, ET-1>1.77 pg/ml detected a bad postoperative outcome with a sensitivity and specificity of 79% and 85%, respectively, and a likelihood ratio of 5.2.

Conclusion: ET-1 levels in CTEPH closely correlated with the hemodynamic and clinical severity of disease in a large cohort of patients. Preoperative ET-1 levels may be useful for better identification of patients at risk for persistent pulmonary hypertension after PEA.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Endarterectomy
  • Endothelin-1 / blood*
  • Endothelin-1 / physiology
  • Female
  • Hemodynamics / physiology*
  • Humans
  • Hypertension, Pulmonary / blood*
  • Hypertension, Pulmonary / etiology
  • Hypertension, Pulmonary / physiopathology*
  • Male
  • Middle Aged
  • Pulmonary Artery / physiopathology
  • Pulmonary Embolism / blood*
  • Pulmonary Embolism / complications
  • Pulmonary Embolism / physiopathology*
  • Pulmonary Embolism / surgery
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Treatment Outcome
  • Vascular Resistance / physiology


  • Endothelin-1