Episodes of acute heart failure syndrome are associated with increased levels of troponin and extracellular matrix markers.
BACKGROUND
Increased myocyte loss and extracellular matrix (ECM) turnover are central mechanisms that contribute to pathological myocardial remodeling in chronic heart failure (HF). We tested the hypothesis that episodes of acute HF syndrome (AHFS) are associated with transient increases in markers of myocyte injury and ECM turnover beyond those observed in chronic stable HF.


RESULTS
Markers of myocyte injury and ECM turnover were assessed in 80 patients prospectively divided into 3 groups: AHFS (n=39); chronic stable systolic HF (n=21); and control subjects without HF (n=20). Myocyte injury was assessed by measuring plasma troponin I. ECM turnover was assessed by measuring plasma matrix metalloproteinases, tissue inhibitors of matrix metalloproteinases, and procollagen N-terminal type I and procollagen type III N-terminal peptides. In the AHFS group, biomarkers were obtained (1) at the time of hospital admission for an episode of HF decompensation, (2) at the time of hospital discharge, and (3) several weeks after discharge in patients who had returned to a chronic stable compensated state. In patients with stable HF (versus non-HF controls), there was a small increase in troponin I and little or no difference in any marker of ECM turnover. In patients with AHFS, troponin I and 3 markers of ECM turnover (matrix metalloproteinases-2, tissue inhibitors of matrix metalloproteinases-1, and procollagen type III N-terminal peptides) were elevated (versus chronic stable HF), and all fell toward chronic HF levels in patients who returned to a compensated state.


CONCLUSIONS
Episodes of AHFS are associated with transient increases in markers of myocyte injury and ECM turnover that may reflect an acceleration of pathological myocardial remodeling during AHFS.
Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA.
Andreia
A
Biolo
Mark
M
Fisch
Joshua
J
Balog
Tania
T
Chao
P Christian
PC
Schulze
Henry
H
Ooi
Deborah
D
Siwik
Wilson S
WS
Colucci
D000328:Adult; D000368:Aged; D015415:Biomarkers; D016022:Case-Control Studies; D005109:Extracellular Matrix / Q000378:metabolism*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008297:Male; D020782:Matrix Metalloproteinases / Q000097:blood; D008875:Middle Aged; D032383:Myocytes, Cardiac / Q000378:metabolism*; D010446:Peptide Fragments / Q000097:blood; D011347:Procollagen / Q000097:blood; D019714:Tissue Inhibitor of Metalloproteinases / Q000097:blood; D014336:Troponin / Q000097:blood*; D020257:Ventricular Remodeling
D015415:Biomarkers; D010446:Peptide Fragments; D011347:Procollagen; D019714:Tissue Inhibitor of Metalloproteinases; D014336:Troponin; C047202:procollagen Type I N-terminal peptide; C041876:procollagen Type III-N-terminal peptide; D020782:Matrix Metalloproteinases