title: Reverse ventricular remodelling after cardiac resynchronization therapy is associated with a reduction in serum tenascin-C and plasma matrix metalloproteinase-9 levels.
abstract: BACKGROUND
  In heart failure patients, cardiac resynchronization therapy (CRT) leads to reverse ventricular remodelling.
  
  
  OBJECTIVE
  The aim of this study was to evaluate whether changes in levels of circulating biomarkers of extracellular matrix metabolism correlate with the response to CRT.
  
  
  RESULTS
  Clinical parameters, left ventricular (LV) volumes, and circulating levels of tenascin-C (TNC), matrix metalloproteinase-2 (MMP-2), MMP-9, and amino-terminal propeptide of brain natriuretic peptide (NT-proBNP) were assessed in 64 patients at baseline and 6 months follow-up. The majority of patients (72%) showed a >10% reduction in LV end-systolic volume at follow-up, and were classified as responders to CRT. The remaining patients were classified as non-responders. In responders, a significant decrease in circulating levels of TNC (from 60+/-40 ng/mL to 47+/-30 ng/mL, p<0.01), MMP-9 (from 55+/-30 AU to 44+/-27 AU, p<0.01), and NT-proBNP (from 2106+/-1805 pg/mL to 1132+/-1289 pg/mL, p<0.001) were observed at follow-up; MMP-2 levels were unchanged. In non-responders TNC, NT-proBNP, MMP-9 and MMP-2 levels remained unchanged.
  
  
  CONCLUSIONS
  At 6 months follow-up, CRT was associated with reverse LV remodelling, and a significant decrease in TNC, MMP-9, and NT-proBNP levels. This suggests an important role of ECM modulation in the process of reverse ventricular remodelling in patients responding to CRT.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marleen H M
authors.initials: MH
authors.lastname: Hessel
authors.forename: Gabe B
authors.initials: GB
authors.lastname: Bleeker
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Henneman
authors.forename: Brigit
authors.initials: B
authors.lastname: den Adel
authors.forename: Margreet
authors.initials: M
authors.lastname: Klok
authors.forename: M J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Douwe E
authors.initials: DE
authors.lastname: Atsma
authors.forename: Arnoud
authors.initials: A
authors.lastname: van der Laarse
mesh_terms: D000368:Aged; D015415:Biomarkers; D002304:Cardiac Pacing, Artificial; D005109:Extracellular Matrix; D005260:Female; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011446:Prospective Studies; D019063:Tenascin / Q000097:blood*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000473:pathology* / Q000628:therapy; D020257:Ventricular Remodeling
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D019063:Tenascin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9