title: Circulating matrix metalloproteinase-3 and metalloproteinase-9 and tissue Doppler measures of diastolic dysfunction to risk stratify patients with systolic heart failure.
abstract: Abnormal matrix metalloproteinase (MMP) activity and diastolic dysfunction may affect left ventricular (LV) remodeling and prognosis, but it is not known whether the combined evaluation of MMP-3 and MMP-9 and variables of diastolic dysfunction are useful for the risk stratification of patients with systolic heart failure (HF). Therefore, this study was designed to assess the value of combining circulating levels of MMPs and tissue Doppler measures of LV diastolic dysfunction to risk-stratify patients with systolic HF. Consecutive patients with systolic HF due to either ischemic or nonischemic cardiomyopathy (n = 134) and LV ejection fractions <45% were submitted to complete echocardiographic and Doppler examinations. The ratio of mitral E peak velocity and averaged e' velocity (E/e') was calculated. Plasma levels of MMP-3 and MMP-9 were measured at the time of index echocardiography. All-cause mortality was defined as the end point. The mean LV ejection fraction was 28 +/- 9%. There was a total of 32 deaths during follow-up (24 +/- 14 months). Several clinical, biochemical, Doppler, and echocardiographic parameters were associated with the outcome on univariate Cox regression analysis. After statistical adjustment for the potentially confounding factors by multivariate analysis, E/e' (hazard ratio 1.11, p = 0.0028), ejection fraction (hazard ratio 0.92, p = 0.017), and MMP-9 (hazard ratio 1.01, p = 0.027) remained significant independent predictors of the end point. Kaplan-Meier curves showed that survival was worse in patients with E/e' ratios >/=13 and MMP-9 levels >89.9 ng/mL (p <0.0001). In conclusion, the assessment of circulating MMP levels and tissue Doppler measures of LV diastolic dysfunction may improve the prognostic stratification of patients with systolic HF.
authors.affiliation: Internal Medicine Department, University of Pisa, Pisa, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Buralli
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Ballo
authors.forename: Umberto
authors.initials: U
authors.lastname: Conti
authors.forename: Paolo
authors.initials: P
authors.lastname: Fontanive
authors.forename: Emiliano
authors.initials: E
authors.lastname: Duranti
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Metelli
authors.forename: Mario
authors.initials: M
authors.lastname: Marzilli
authors.forename: Stefano
authors.initials: S
authors.lastname: Taddei
mesh_terms: D000369:Aged, 80 and over; D003971:Diastole; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D054143:Heart Failure, Systolic / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D019278:Matrix Metalloproteinase 3 / Q000097:blood*; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D011379:Prognosis; D018570:Risk Assessment; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D019278:Matrix Metalloproteinase 3; D020780:Matrix Metalloproteinase 9