[Ventricular remodeling and matrix metalloproteinase-1 and its tissue inhibitor of metalloproteinase-1 in serum in third trimester of pregnant women with cardiac disease.].
OBJECTIVE
To analyse the relationship between the left ventricular (LV) structure, function and changes of concentration of serum matrix metalloproteinase-1 (MMP-1), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), and evaluate the value of the change of serum MMP-1 and serum TIMP-1 in ventricular remodeling of pregnant women complicating cardiac disease.


METHODS
Fifty-eight cases of pregnant women with cardiac disease divided into three groups [group A had 17 cases who had clinical manifestations and no left ventricular hypertrophy (LVH)], group B had 15 cases who had clinical manifestations and LVH but no pulmonary hypertension (PH), group C had 26 cases who had clinical manifestations, LVH and PH which divided into three groups again: 11 cases of slight group [PH from 30 - 49 mm Hg (1 mm Hg = 0.133 kPa)], 9 cases of moderate group (PH from 50 - 79 mm Hg) and 6 cases of severe group (PH >/= 80 mm Hg). Fifteen healthy pregnant women acted as control group. The left ventricular structure and function [(left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDd), Ejection fraction (EF), E peak (E), A peak (A) and E/A], pulmonary pressure and plasma MMP-1, TIMP-1 values were determined in the third trimester of pregnancy.


RESULTS
(1) LVMI (148 +/- 7) g/m(2) and LVEDd (58.9 +/- 3.5) mm in group C increased significantly (totally P < 0.01), EF (51.0 +/- 4.4)% decreased significantly (P < 0.01), E (50 +/- 10) cm/s decreased significantly (P < 0.01), A (81 +/- 13) cm/s increased (P < 0.05) and E/A (0.6 +/- 0.3) decreased significantly (P < 0.01) compared with normal subjects, group A and group B. (2) LVMI (150 +/- 7) g/m(2), LVEDd (69.7 +/- 3.4) mm in severe pulmonary hypertension group increased significantly (P < 0.01), EF (45.6 +/- 2.6)% decreased significantly (P < 0.01), E (44 +/- 9) cm/s decreased (P < 0.05), A (86 +/- 8) cm/s increased (P < 0.05) and E/A (0.52 +/- 0.17) decreased significantly(P < 0.01) compared with slight and moderate pulmonary hypertension group. (3) Plasma MMP-1 (41 +/- 10) microg/L and TIMP-1 (393 +/- 37) microg/L values in group C increased significantly compared with normal subjects, group A and group B (P < 0.01).(4) Plasma MMP-1 (42 +/- 7) microg/L and TIMP-1 (411 +/- 31) microg/L values of severe pulmonary hypertension group increased significantly compared with slight pulmonary hypertension group (P < 0.05, P < 0.01). (5) The correlation analysis indicated that: There was positive correlation between the serum concentration of MMP-1 and TIMP-1 (r = 0.587, P < 0.01). The serum concentration of MMP-1 was positively correlated with LVMI and LVEDd significantly (r = 0.782, P < 0.001; r = 0.648, P < 0.01) and was negatively correlated with EF significantly (r = -0.587, P < 0.01). (6) Plasma MMP-1 values > 50 microg/L and plasma TIMP-1 values > 450 microg/L in 3 cardiac disease failure cases.


CONCLUSIONS
(1) The ventricular remodeling can be found in the third trimester of pregnancy of women complicating cardiac disease, and the more serious the left ventricular hypertrophy and PH, the more obvious the ventricular remodeling. (2) The changes in the plasma MMP-1/TIMP-1 values and MMP-1/TIMP-1 balance may play an important role in the left ventricular structural, functional, and clinical manifestations of pregnant women complicating cardiac disease. (3) An increased MMP-1 and TIMP-1 level maybe can predict the presence of cardiac disease failure.
Zhang
Zhi-Ling
ZL
Department of Obsterics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
Lin
Jian-Hua
JH
Tao
Ru-Qi
RQ
D005260:Female; D006331:Heart Diseases; D006801:Humans; D020781:Matrix Metalloproteinase 1; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D019715:Tissue Inhibitor of Metalloproteinase-1; D020257:Ventricular Remodeling
D019715:Tissue Inhibitor of Metalloproteinase-1; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9; D020781:Matrix Metalloproteinase 1