Residual stress ischaemia is associated with blood markers of myocardial structural remodelling

Background: Long‐term prognosis of coronary artery disease (CAD) patients is worsened when stress ischemia persists on treatment, but the relationship with adverse cardiac remodelling had never been investigated. Aim: To analyze changes in blood markers of fibrosis in patients with chronic CAD exhibiting exercise ischaemia. Methods: Circulating markers of collagen: (i) turnover (amino‐terminal propeptide of collagen‐III [PIIINP]) and (ii) degradation (matrix metalloproteinase 1 [MMP‐1]), were obtained in 139 CAD patients referred for exercise 201 Tl‐SPECT. Results: In the 57 patients who had SPECT‐ischaemia, PIIINP was higher (4.3±2.9 μg L −1 vs. 3.1±1.5 μg L −1 , p =0.002) and MMP‐1 lower (3.8±2.1 μg L −1 vs. 4.7±2.8 μg L −1 , p =0.04) than in the 82 patients without SPECT‐ischaemia. PIIINP was independently related to LV volume, SPECT‐ischaemia and age, whereas MMP‐1 was related to current treatment with ACEI and β‐blockers ( p <0.05). In the 104 patients with a normal LV ejection fraction, only PIIINP was related to SPECT‐ischaemia (4.1±2.2 μg L −1 vs. 3.1±1.5 μg L −1 , p =0.01). Conclusion: In patients with chronic CAD, exercise ischaemia is associated with increased collagen‐III turnover, independently of concomitant medications and even when LV ejection fraction is normal. Long‐term, this increase might relate to adverse cardiac remodelling even when cardiac function is not clearly affected at baseline.