Document Detail


Diagnosis of heart failure with preserved ejection fraction: improved accuracy with the use of markers of collagen turnover.
MedLine Citation:
PMID:  19168518     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Heart failure with preserved ejection fraction (HF-PEF) can be difficult to diagnose in clinical practice. Myocardial fibrosis is a major determinant of diastolic dysfunction (DD), potentially contributing to the progression of HF-PEF. The aim of this study was to analyse whether serological markers of collagen turnover may predict HF-PEF and DD.
METHODS AND RESULTS: We included 85 Caucasian treated hypertensive patients (DD n=65; both DD and HF-PEF n=32). Serum carboxy (PICP), amino (PINP), and carboxytelo (CITP) peptides of procollagen type I, amino (PIIINP) peptide of procollagen type III, matrix metalloproteinases (MMP-1, MMP-2, and MMP-9), and tissue inhibitor of MMP levels were assayed. Using receiver operating characteristic curve analysis, MMP-2 (AUC=0.91; 95% CI: 0.84, 0.98), CITP (0.83; 0.72, 0.92), PICP (0.82; 0.72, 0.92), B-type natriuretic peptide (BNP) (0.82; 0.73, 0.91), MMP-9 (0.79; 0.68, 0.89), and PIIINP (0.78; 0.66, 0.89) levels were significant predictors of HF-PEF (P<0.01 for all). Carboxytelo peptides of procollagen type I (AUC=0.74; 95% CI: 0.62, 0.86), MMP-2 (0.73; 0.62, 0.84), PIIINP (0.73; 0.60, 0.85), BNP (0.69; 0.55, 0.83) and PICP (0.66; 0.54, 0.78) levels were significant predictors of DD (P<0.05 for all). A cutoff of 1585 ng/mL for MMP-2 provided 91% sensitivity and 76% specificity for predicting HF-PEF and combinations of biomarkers could be used to adjust either sensitivity or specificity.
CONCLUSION: Markers of collagen turnover identify patients with HF-PEF and DD. Matrix metalloproteinase 2 may be more useful than BNP in the identification of HF-PEF. This suggests that these new biochemical tools may assist in identifying patients with these diagnostically challenging conditions.
Authors:
Ramón Martos; John Baugh; Mark Ledwidge; Christina O'Loughlin; Niamh F Murphy; Carmel Conlon; Anil Patle; Seamas C Donnelly; Kenneth McDonald
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of heart failure     Volume:  11     ISSN:  1388-9842     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-26     Completed Date:  2009-04-16     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  191-7     Citation Subset:  IM    
Affiliation:
Heart Failure Unit, School of Medicine and Medical Science, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers / blood
Collagen / metabolism*
Collagen Type I / blood
Collagen Type III / blood
Female
Heart Failure / diagnosis*,  metabolism,  physiopathology
Heart Failure, Diastolic / diagnosis
Humans
Male
Matrix Metalloproteinases / blood
Middle Aged
Peptides / blood
Sensitivity and Specificity
Stroke Volume*
Tissue Inhibitor of Metalloproteinase-1 / blood
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Collagen Type I; 0/Collagen Type III; 0/Peptides; 0/Tissue Inhibitor of Metalloproteinase-1; 0/collagen type I trimeric cross-linked peptide; 9007-34-5/Collagen; EC 3.4.24.-/Matrix Metalloproteinases
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