title: Plasma metalloproteinase-9 and restrictive filling pattern as major predictors of outcome in patients with ischemic cardiomyopathy.
abstract: OBJECTIVE
  Assessment of plasma matrix metalloproteinase-9 (MMP-9) and Doppler markers of increased left ventricular (LV) filling pressure may be added to risk stratify patients with ischemic cardiomyopathy (IC). Therefore, we aimed at investigating the value of plasma MMP-9 and restrictive filling pattern (RFP) in IC patients.
  
  
  METHODS
  Eighty-eight consecutive patients hospitalized for heart failure (LV ejection fraction ≤ 40%) due to IC were enrolled. A complete M-mode and two-dimensional echo-Doppler examination were performed. Patients were defined as having RFP if they had a mitral E wave deceleration time<150 ms. Plasma MMP-9 and N-terminal protype-B natriuretic peptide levels were assessed at the time of the index echocardiogram. The end point was all-cause mortality or hospitalization for worsening HF. Follow-up period was 25 ± 17 months.
  
  
  RESULTS
  Median value of MMP-9 was 714 ng/ml. On univariate analysis, a number of measurements predicted the composite end point: NYHA class>2, RFP, MMP-9>60.5 ng/ml, LV ejection fraction<27%, anemia, pulmonary pressure ≥ 35 mm Hg, N-terminal protype-B natriuretic peptide>1742 pg/ml, and glomerular filtration rate<60 ml/min/1.73 m(2). Independent variables of outcome were anemia (HR=1.9, p=0.031), and the combination of plasma MMP-9 and RFP (HR=3.2, p=0.004). On Kaplan-Meier survival curves, patients with elevated MMP-9 levels and RFP had the lowest event-free survival rate (log-rank: 29.0, p<0.0001). The net reclassification improvement showed a significant increase in the prediction model when elevated MMP-9 and RFP were added to the base model that included clinical, biochemical and echocardiographic parameters (p<0.0001).
  
  
  CONCLUSIONS
  MMP-9 levels and RFP have an incremental predictive value to risk classify IC patients.
authors.affiliation: Service of Cardiology, Internal Medicine Clinic, University Clinical Centre of Kosova, Prishtina, Kosovo.
authors.forename: Gani
authors.initials: G
authors.lastname: Bajraktari
authors.forename: Mario
authors.initials: M
authors.lastname: Miccoli
authors.forename: Simona
authors.initials: S
authors.lastname: Buralli
authors.forename: Paolo
authors.initials: P
authors.lastname: Fontanive
authors.forename: Shpend
authors.initials: S
authors.lastname: Elezi
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Metelli
authors.forename: Angelo
authors.initials: A
authors.lastname: Baggiani
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D009202:Cardiomyopathies / Q000097:blood / Q000201:enzymology* / Q000209:etiology / Q000401:mortality; D018572:Disease-Free Survival; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000201:enzymology* / Q000209:etiology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D009203:Myocardial Infarction / Q000150:complications*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D018570:Risk Assessment; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000201:enzymology* / Q000209:etiology / Q000401:mortality; D020257:Ventricular Remodeling
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D020780:Matrix Metalloproteinase 9