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Cardiac extracellular matrix is associated with adverse outcome in patients with chronic heart failure
Author(s) -
Duca Franz,
ZotterTufaro Caroline,
Kammerlander Andreas A.,
Panzenböck Adelheid,
Aschauer Stefan,
Dalos Daniel,
Köll Benedikt,
Börries Benedikt,
Agis Hermine,
Kain Renate,
Aumayr Klaus,
Klinglmüller Florian,
Mascherbauer Julia,
Bonderman Diana
Publication year - 2017
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.680
Subject(s) - medicine , heart failure , cardiology , hazard ratio , ejection fraction , pulmonary wedge pressure , pulmonary artery , hemodynamics , confidence interval
Aims Accumulation of extracellular matrix ( ECM ) is known to play a crucial role in the pathophysiology of heart failure ( HF ). However, its prognostic relevance is poorly investigated. Methods and results A total of 73 HF patients who underwent LV endomyocardial biopsy were enrolled in our study. ECM area was quantified by TissueFAXS and ImageJ software. Patients were followed‐up at 6‐month intervals. The study endpoint was defined as hospitalization for a cardiac reason and/or cardiac death. Furthermore, the influence of the ECM on invasively measured haemodynamic parameters was tested. During a median follow‐up period of 9.0 months, 34 patients (46.6%) reached the combined endpoint. Median ECM area was 30.5%. Patients with ECM area ≥30.5% experienced significantly more events (67.6% vs. 25.0%, P < 0.001) in comparison with patients with an ECM area <30.5%. ECM area was independently associated with outcome in the total HF cohort [hazard ratio ( HR ) 1.041, 95% confidence interval ( CI ) 1.017–1.066, P = 0.001] as well as in HF patients with preserved ( HR 1.079, 95% CI 1.001–1.163, P =0 .046) or reduced ejection fraction ( HR 1.149, 95% CI 1.036–1.275, P = 0.009). Positive correlations were found between ECM area and LV end‐diastolic pressure ( P = 0.021, R = 0.303), pulmonary artery wedge pressure ( P = 0.042, R = 0.249), mean pulmonary arterial pressure ( P = 0.035, R = 0.258), as well as right atrial pressure ( P = 0.003, R = 0.353). Conclusion ECM area within the LV myocardium correlates with left and right heart haemodynamics and is associated with clinical course in various non‐ischaemic HF types.