Premium
Diagnosis of heart failure with preserved ejection fraction: improved accuracy with the use of markers of collagen turnover
Author(s) -
Martos Ramón,
Baugh John,
Ledwidge Mark,
O'Loughlin Christina,
Murphy Niamh F.,
Conlon Carmel,
Patle Anil,
Donnelly Seamas C.,
McDonald Kenneth
Publication year - 2009
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 - 10.1093/eurjhf/hfn036
Subject(s) - medicine , ejection fraction , natriuretic peptide , heart failure , procollagen peptidase , myocardial fibrosis , cardiology , fibrosis , area under the curve , matrix metalloproteinase , receiver operating characteristic , gastroenterology , endocrinology
Aims Heart failure with preserved ejection fraction (HF‐PEF) can be difficult to diagnose in clinical practice. Myocardial fibrosis is a major determinant of diastolic dysfunction (DD), potentially contributing to the progression of HF‐PEF. The aim of this study was to analyse whether serological markers of collagen turnover may predict HF‐PEF and DD. Methods and results We included 85 Caucasian treated hypertensive patients (DD n = 65; both DD and HF‐PEF n = 32). Serum carboxy (PICP), amino (PINP), and carboxytelo (CITP) peptides of procollagen type I, amino (PIIINP) peptide of procollagen type III, matrix metalloproteinases (MMP‐1, MMP‐2, and MMP‐9), and tissue inhibitor of MMP levels were assayed. Using receiver operating characteristic curve analysis, MMP‐2 (AUC = 0.91; 95% CI: 0.84, 0.98), CITP (0.83; 0.72, 0.92), PICP (0.82; 0.72, 0.92), B‐type natriuretic peptide (BNP) (0.82; 0.73, 0.91), MMP‐9 (0.79; 0.68, 0.89), and PIIINP (0.78; 0.66, 0.89) levels were significant predictors of HF‐PEF ( P < 0.01 for all). Carboxytelo peptides of procollagen type I (AUC = 0.74; 95% CI: 0.62, 0.86), MMP‐2 (0.73; 0.62, 0.84), PIIINP (0.73; 0.60, 0.85), BNP (0.69; 0.55, 0.83) and PICP (0.66; 0.54, 0.78) levels were significant predictors of DD ( P < 0.05 for all). A cutoff of 1585 ng/mL for MMP‐2 provided 91% sensitivity and 76% specificity for predicting HF‐PEF and combinations of biomarkers could be used to adjust either sensitivity or specificity. Conclusion Markers of collagen turnover identify patients with HF‐PEF and DD. Matrix metalloproteinase 2 may be more useful than BNP in the identification of HF‐PEF. This suggests that these new biochemical tools may assist in identifying patients with these diagnostically challenging conditions.