© 2007 European Society of Cardiology
Residual stress ischaemia is associated with blood markers of myocardial structural remodelling
a Centre Investigation Clinique (CIC) CHU-INSERM Nancy, France
b Unité mixte UHP-INSERM U684 "Rigidité, Fibrose et Risque Cardio-Vasculaire", CHU Nancy, France
c Département des Maladies Cardiovasculaires CHU Nancy, France
d Service de Médecine Nucléaire CHU Nancy, France
e Laboratoire Central de Chimie CHU Nancy, France
f Service d'Epidémiologie et Evaluation Clinique CHU Nancy, France
* Corresponding author. Centre d'Investigation Clinique (CIC) CHU-INSERM, Hôpital Jeanne d'Arc, BP 303, 54201 Dommartin-lès-Toul, France. Tel.: +33 3 83 65 66 25; fax: +33 3 83 65 66 19. E-mail address: f.zannad{at}chu-nancy.fr
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Abstract |
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Background: Long-term prognosis of coronary artery disease (CAD) patients is worsened when stress ischemia persists on treatment, but the relationship with adverse cardiac remodelling had never been investigated.
Aim: To analyze changes in blood markers of fibrosis in patients with chronic CAD exhibiting exercise ischaemia.
Methods: Circulating markers of collagen: (i) turnover (amino-terminal propeptide of collagen-III [PIIINP]) and (ii) degradation (matrix metalloproteinase 1 [MMP-1]), were obtained in 139 CAD patients referred for exercise 201Tl-SPECT.
Results: In the 57 patients who had SPECT-ischaemia, PIIINP was higher (4.3±2.9 µg L–1 vs. 3.1±1.5 µg L–1, p=0.002) and MMP-1 lower (3.8±2.1 µg L–1 vs. 4.7±2.8 µg L–1, p=0.04) than in the 82 patients without SPECT-ischaemia. PIIINP was independently related to LV volume, SPECT-ischaemia and age, whereas MMP-1 was related to current treatment with ACEI and β-blockers (p<0.05).
In the 104 patients with a normal LV ejection fraction, only PIIINP was related to SPECT-ischaemia (4.1±2.2 µg L–1 vs. 3.1±1.5 µg L–1, p=0.01).
Conclusion: In patients with chronic CAD, exercise ischaemia is associated with increased collagen-III turnover, independently of concomitant medications and even when LV ejection fraction is normal. Long-term, this increase might relate to adverse cardiac remodelling even when cardiac function is not clearly affected at baseline.
Key Words: Coronary artery disease • Exercise ischaemia • SPECT • Remodelling • Collagen • Fibrosis
Received November 23, 2005; Revised June 8, 2006; Accepted September 25, 2006
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