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(Circulation. 2001;104:I-54.)
© 2001 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Regression of Left Ventricular Hypertrophy After Surgical Therapy for Aortic Stenosis Is Associated With Changes in Extracellular Matrix Gene Expression

Thomas Walther, MD, PhD; Andreas Schubert, PhD; Volkmar Falk, MD, PhD; Christian Binner, MD; Andreas Kanev; Sabine Bleiziffer; Claudia Walther, MD; Nico Doll, MD; Rüdiger Autschbach, MD, PhD; Friedrich W. Mohr, MD, PhD

Department of Cardiac Surgery, Heartcenter, University Leipzig, Leipzig, Germany.

Correspondence to Dr Thomas Walther, University Leipzig, Heartcenter, Cardiac Surgery, Russenstrasse 19, D-04289 Leipzig, Germany. E-mail walt{at}medizin.uni-leipzig.de

Background— Regression of left ventricular hypertrophy (LVH) after surgical correction for aortic stenosis is not fully understood on the molecular level. The aim of this study was to examine whether there is an association between LVH regression and extracellular matrix (ECM) gene expression.

Methods and Results— A standard model of controlled LVH induction by supracoronary banding (A=baseline) was applied in 44 growing sheep (age, 6 to 8 months). Surgical correction to release the pressure gradient was performed 8.3±1 months later (B). The animals were killed after another 10.1±2 months (C). At all time points, hemodynamic evaluations and quantitative analysis of mRNA and protein expression for matrix metalloproteinases (MMP) and their tissue inhibitors (TIMP) was performed. Left ventricular mass index was 82±21 (A) versus 150±33 (B), P<0.01, and 78±18 g/m² (C), P<0.01. Left ventricular function and cardiac index remained stable. Myocardial fiber diameter index was 9.1±1.2 (A) versus 12.3±1.4 (B), P<0.01, and 8.4±1.3 µm/m² (C), P<0.01. In parallel to the development of LVH at B, gene expression was increased significantly for MMP-1, MMP-2, MMP-3, and MMP-9 and for TIMP-1 and TIMP-2 and decreased significantly for TIMP-3. After surgical correction (C), there was a complete regression of gene expression to baseline measures.

Conclusions— Controlled induction of compensated LVH leads to significant increase in ECM gene expression. The regression of LVH after surgical therapy is associated with complete regression of ECM gene expression. However, no cause-and-effect relation could be demonstrated.

Key Words: stenosis • hypertrophy • aorta • genes