title: Plasma matrix metalloproteinase-9 level is correlated with left ventricular volumes and ejection fraction in patients with heart failure.
abstract: BACKGROUND
  Matrix metalloproteinases (MMPs) can alter myocardial extracellular matrix and thereby contribute to adverse ventricular remodeling in progressive heart failure (HF). We hypothesized that increased plasma MMP levels correlate with increased left ventricular (LV) volumes and reduced LV ejection fraction (LVEF) in patients with HF.
  
  
  RESULTS
  In the Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) trial, patients with symptomatic HF and LVEF <0.40 were randomized to receive various combinations of therapies with candesartan, enalapril, and metoprolol CR. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), and LVEF were determined by radionuclide angiography at baseline and at Week 43. Baseline and Week 43 plasma MMP-2, MMP-9, and tissue inhibitor of metalloproteinase-1 (TIMP-1) were measured by enzyme-linked immunosorbent assay in 184 patients in this substudy. At baseline, plasma MMP-9 correlated positively with ESV (Spearman's rank correlation coefficient rho = 0.17, P = .02) and negatively with LVEF (rho = -0.18, P = .01). After 43 weeks, LVEF, EDV, and ESV increased significantly (all P < .01); MMP-2 level increased (P = .01), but MMP-9 and TIMP-1 levels did not change significantly overall in the study population. Temporal changes in MMP-9 level were inversely correlated with changes in LVEF (rho = -0.16, P = .04). In multivariable analysis adjusting for clinical characteristics and treatment, a smaller proportional change in MMP-9 level after 43 weeks (below versus above median) predicted a concurrent improvement in LVEF (odds ratio = 2.35, 95% CI 1.24-4.46; P < .01). Similar relationships for MMP-2 and TIMP-1 were not observed.
  
  
  CONCLUSIONS
  Elevated plasma MMP-9 levels correlated with lower LVEF and higher ESV, whereas increasing MMP-9 levels are associated with a concurrent deterioration of LV function. These findings suggest that monitoring of plasma markers of myocardial matrix remodeling may provide important prognostic information with respect to ongoing adverse LV remodeling in HF patients.
authors.affiliation: Heart & Stroke/Richard Lewar Centre of Excellence, Toronto, Ontario, Canada.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Yan
authors.forename: Francis G
authors.initials: FG
authors.lastname: Spinale
authors.forename: Rizwan
authors.initials: R
authors.lastname: Afzal
authors.forename: Himali R
authors.initials: HR
authors.lastname: Gunasinghe
authors.forename: Malcolm
authors.initials: M
authors.lastname: Arnold
authors.forename: Catherine
authors.initials: C
authors.lastname: Demers
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
authors.forename: Peter P
authors.initials: PP
authors.lastname: Liu
mesh_terms: D000368:Aged; D002303:Cardiac Output, Low / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000097:blood; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010865:Pilot Projects; D011875:Radionuclide Angiography; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D013997:Time Factors; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood
chemical_list: D019715:Tissue Inhibitor of Metalloproteinase-1; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9