title: Tenascin-C as predictor of left ventricular remodeling and mortality in patients with dilated cardiomyopathy.
abstract: BACKGROUND
  Several cardiac biomarkers, especially brain natriuretic peptide (BNP) and N-terminal (NT)-proBNP, have been used as predictors of prognosis and negative remodeling in DCM. In the present study, we aimed to evaluate the prognostic value of tenascin-C in dilated cardiomyopathy (DCM) and whether it can be used to determine reverse remodeling in patients with DCM.
  
  
  METHODS
  Sixty-six patients with DCM were followed up for 12 months after initiation of medical treatment including carvedilol, ramipril (candesartan if ramipril was not tolerated), spironolactone, and furosemide. Tenascin-C and NT-proBNP measurements and transthoracic echocardiography were performed at baseline and at 12 months.
  
  
  RESULTS
  At 12 months, a significant improvement in New York Heart Association class (2.57 ± 0.6 vs. 1.87 ± 0.5; P < 0.0001), left ventricular end-diastolic volume (217 ± 47 vs 203 ± 48; P < 0.0001), left ventricular ejection fraction (29.1 ± 5.5 vs 30.9 ± 3.8; P < 0.0001), NT-proBNP (2019 ± 558 vs 1462 ± 805; P < 0.0001), and tenascin-C (76 ± 19 vs 48 ± 28; P < 0.0001) values were observed, compared with baseline. Importantly, decrease in tenascin-C values were correlated with increase in left ventricular ejection fraction. Tenascin-C (odds ratio [OR], 1.896; <95% confidence interval [CI], 1.543-2.670; P = 0.02), diabetes mellitus (OR, 2.456; G95% CI, 1.987-3.234; P = 0.01) and hypertension (OR: 2.106, <95% CI, 1.876-2.897; P = 0.03) were independent predictors of mortality in patients with DCM.
  
  
  CONCLUSIONS
  Reverse ventricular remodeling obtained with carvedilol, ramipril/candesartan, and spironolacton is associated with decreases in left ventricular end-diastolic volume, left ventricular end-systolic volume, tenascin-C levels, and NT-proBNP levels. Consequently, tenascin-C may be used to evaluate reverse remodeling in patients with DCM.
authors: Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey. drsarli@yahoo.com
authors: Bahadir
authors: B
authors: Sarli
authors: Ramazan
authors: R
authors: Topsakal
authors: Esma G
authors: EG
authors: Kaya
authors: Mahmut
authors: M
authors: Akpek
authors: Yat Yin
authors: YY
authors: Lam
authors: Mehmet G
authors: MG
authors: Kaya
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D001713:Biphenyl Compounds; D002227:Carbazoles / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D000077261:Carvedilol; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006334:Heart Function Tests; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011412:Propanolamines / Q000627:therapeutic use; D017257:Ramipril / Q000627:therapeutic use; D013148:Spironolactone / Q000627:therapeutic use; D015996:Survival Rate; D019063:Tenascin / Q000097:blood*; D013777:Tetrazoles / Q000627:therapeutic use; D014421:Turkey / Q000453:epidemiology; D020257:Ventricular Remodeling / Q000187:drug effects / Q000502:physiology*
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D002227:Carbazoles; D011412:Propanolamines; D019063:Tenascin; D013777:Tetrazoles; D000077261:Carvedilol; D013148:Spironolactone; D005665:Furosemide; D017257:Ramipril; C081643:candesartan