Inflammatory markers and circulating extracellular matrix proteins in patients with chronic obstructive pulmonary disease and left ventricular diastolic dysfunction

Background Left ventricular diastolic dysfunction (LVDD) is a frequent condition in chronic obstructive pulmonary disease (COPD). Tenascin‐C (Tn‐C) and matrix metalloproteinase‐9 (MMP‐9) are extracellular matrix proteins associated with myocardial fibrosis and wall remodeling because of inflammation. Objective To determine whether the circulating levels of inflammatory markers, Tn‐C and MMP‐9 are associated with LVDD in COPD patients. Methods Forty‐two severe stable COPD patients (64 ± 8 years, 88% male, FEV1% 38 ± 5.7) and a control group ( n  = 11) were included. Pulmonary function tests and a Doppler echocardiography were performed on COPD patients. Baseline serum levels of C‐reactive protein (CRP), leukocytes, fibrinogen, interleukins (IL) 6 and 8, Tn‐C and MMP‐9 were analyzed in all participants. Results COPD patients were classified in two groups: LVDD ( n  = 35) and non‐LVDD ( n  = 7). Serum levels of IL‐6 and CRP were higher in the LVDD group compared to the non‐LVDD group [median(IQR)] [3.46 pg/mL (2.36–4.74) vs 1.87 pg/mL (1.10–3.28), P  = 0.045] and [6.0 mg/L (3.0–13.0) vs 1.0 mg/L (1.0–2.3), P  = 0.001], respectively. The same trend was observed in the analysis adjusted by age and BMI, being significant for CRP ( P  = 0.04). Circulating IL‐6 was associated with the type of LVDD, being higher in the type‐II ( P  = 0.046). Obese patients with COPD‐LVDD showed a higher level of inflammatory markers ( P  = 0.021). Tn‐C were significantly higher in patients with LVDD type‐II compared to type‐I [1422 ng/mL (826–1948) vs 781 ng/mL (640–1139), P  = 0.015], without differences in MMP‐9. Conclusions Severe COPD patients with LVDD showed a different inflammatory pattern, suggesting a link between low‐grade inflammation and the presence of LVDD. In COPD, high levels of Tn‐C are related to LVDD type‐II.