Background
Aim of the study
-
to assess the level of plasma Endothelin-1 in patients with atrial septal defect
-
to evaluate the usefulness of measuring ET-1 levels for the diagnosis and selection of candidates for ASD closure
Material and methods
-
pulmonary artery pressure at systole (PAPs),
-
total pulmonary vascular resistance (TPVR),
-
pulmonary blood flow (Qp),
-
systemic blood flow (Qs),
-
pulmonary/systemic blood flow ratio (Qp/Qs).
-
Clinical examination including assessment of NYHA class
-
Transthoracic echocardiography to measure right ventricular area at diastole (RVarea [cm2]) and right atrial area at diastole (RAarea)
-
Spirometry at rest to measure forced vital capacity expressed as a percentage of the normal value (FVC%), forced expiratory volume in one second expressed as a percentage of the normal value (FEV1%)
-
Exercise spirometry test to measure duration of exercise in seconds (T), peak oxygen consumption VO2peak(ml/kg/min), time to anaerobic threshold (TAT), oxygen consumption at the anaerobic threshold (VO2AT%), ventilatory equivalent for carbon dioxide (VE/VCO2)
Measurement of endothelin levels
-
Subgroup G – ET-1 levels from 0.91 to 2.81 fmol/ml
-
Subgroup H – ET-1 levels from 7.13 to 24.68 fmol/ml
Subgroup G n = 30 | Subgroup H n = 38 | p | |
---|---|---|---|
ET-1 (fmol/ml) | 1.81 ± 1,3 (0.91-2.81) | 9.4 ± 9.2 (7.72-24.68) |
<0,0001
|
Women | 20 (66.7%) | 25 (65.9%) |
NS
|
Men | 10 (33.3%) | 13 (34.1%) |
NS
|
Statistical analysis
Results
ET-1 levels before and after transcatheter closure
Group | Vessel | Mean | Minimum | Maximum | SD |
p ASD II vs. healthy |
---|---|---|---|---|---|---|
ASD II patients before closure n = 80
|
Peripheral artery
| 6,122 | 0,772 | 13,981 | 3,651 | < 0,0001 |
Peripheral vein
| 4,431 | 1,230 | 13,546 | 3,312 | < 0,0001 | |
Pulmonary artery
| 5,541 | 0,91 | 24,68 | 6,874 | - | |
Healthy volunteers n = 19
|
Peripheral artery
| 0,049 | 0,010 | 0,098 | 0,025 | < 0,0001 |
Peripheral vein
| 0,054 | 0,001 | 0,099 | 0,027 | < 0,0001 |
Subgroup G – ET1 from 0,91 to 2,81 fmol/ml | Subgroup H – ET1 from 7,13 to 24,68 fmol/ml |
P
| |
---|---|---|---|
Age
| 35,1 ± 11,43 | 56,36 ± 5,7 |
<0,001
|
Defect size
| 23,1 ± 7,28 | 18,9 ± 4,28 | NS |
RV
area
(cm
2
)
| 23,1 ± 1,01 | 25 ± 1,51 |
< 0,01
|
RA
area
(cm
2
)
| 16,2 ± 1,2 | 19,5 ± 0,9 |
<0,001
|
PAPs (mmHg)
| 20,1 ± 5,2 | 40,01 ± 19,5 |
<0,01
|
Qp (l/min)
| 8,4 ± 2,41 | 8,7 ± 2,5 | NS |
COP (dyn/s/cm
−5
)
| 140,1 ± 24,8 | 189 ± 130,1 | NS |
Qp/Qs
| 2,20 ± 1,31 | 2,34 ± 1,4 | NS |
T (s)
| 734 ± 71,45 | 700,7 ± 90,1 | NS |
VO
2peak
(ml/kg/min)
| 24,13 ± 3,32 | 21,1 ± 3,92 |
<0,05
|
FVC%
| 107,6 ± 14,0 | 89,5 ± 4,7 |
<0,05
|
FEV
1
%
| 93,5 ± 10,2 | 87,3 ± 17 | NS |
T
AT
(s)
| 455,6 ± 44,9 | 390 ± 23,1 |
<0,01
|
VO
2AT
%
| 41,4 ± 2,8 | 35,41 ± 4,5 |
<0,05
|
VE/VCO
2
| 30,4 ± 3,1 | 39 ± 4,4 |
<0,05
|
NYHA
| 1,9 ± 1,08 | 2,39 ± 1,03 | NS |
-
Right atrial area (RAarea) > 17.81 mm (p < 0.0002)
-
Right ventricular area (RVarea) > 23.508 mm (p < 0.0014)
-
Age > 40 years (p < 0.0002)
-
Pulmonary artery pressure at systole (PAPs) > 31.04 mmHg (p < 0.0001)
-
Peak oxygen consumption (VO2peak) < 23.022 ml/kg/min (p < 0.0002)
-
Forced vital capacity (FVC) < 90.07% (p < 0.0115)
-
Time to anaerobic threshold (TAT) < 423.16 second (p < 0.0006)
-
Oxygen consumption at the anaerobic threshold (VO2AT%) < 39.016%VO2 (p < 0.0128)