© 2008 European Society of Cardiology
Myocardial collagen metabolism in failing hearts before and during cardiac resynchronization therapy
Department of Cardiology, Leiden University Medical Center Leiden, The Netherlands
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Abstract |
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Background: In patients with heart failure cardiac resynchronization therapy (CRT) leads to reverse ventricular remodelling.
Aim: To evaluate whether myocardial collagen metabolism in patients with heart failure is implicated in adverse ventricular remodelling and response to CRT.
Methods: Collagen synthesis and degradation were assessed from the concentrations of aminoterminal propeptides of type I and type III collagen (PINP and PIIINP) and carboxyterminal telopeptide of type I collagen (ICTP), respectively, in serum of 64 patients with heart failure before and after 6 months of CRT. Forty-six patients (72%) showed a > 10% reduction in LV end-systolic volume at follow-up and were classified as responders to CRT, the other 18 patients (28%) were classified as non-responders.
Results: Responders demonstrated a mean (±SEM) increase of serum PINP and PIIINP during follow-up, from 32.9±2.2 to 46.7±4.0 µg/L (p<0.001) and from 4.59±0.24 to 5.13±0.36 µg/L (p<0.05), respectively. In non-responders, serum PINP and PIIINP remained unchanged during follow-up. At baseline, responders had significantly lower serum PINP than non-responders (32.9±2.2 vs. 41.8±4.3 µg/L; p<0.05).
ICTP levels of responders at baseline tended to be higher than in non-responders (3.54±0.56 vs. 2.08±0.37 µg/L, p=ns), and in both groups ICTP levels did not change upon CRT.
Conclusion: Reverse LV remodelling following CRT is associated with increased collagen synthesis rate in the first 6 months of follow-up.
Key Words: Heart failure • Cardiac resynchronisation therapy • PINP • PIIINP • ICTP
Received November 21, 2007; Revised May 21, 2008; Accepted June 30, 2008