Abstract 11589: Myocardial Fibrosis is Associated with Heart Failure in Hypertensive Patients: Assessment with Cardiac Magnetic Resonance and Biomarkers of Collagen Turnover
Background: The pathophysiology of heart failure (HF) with preserved ejection fraction is poorly understood. One possible mechanism is an active fibrotic process that produced increased ventricular stiffness. Myocardial fibrosis can be assessed noninvasively with collagen biomarkers and late gadolinium enhancement (LGE) technique in cardiac magnetic resonance (CMR). We hypothesize that presence of LGE and increased collagen turnover are associated with HF in hypertensive patients.
Methods: We studied 60 hypertensive patients with and without HF (31 with, 29 without), in whom CMR were performed. Only patients with preserved ejection fraction (>45%) and renal function (estimated glomerular filtration rate >30ml/min 1.73m2) were included. Serum carboxytelo (CITP) peptides of procllagen type I, amino (PIIINP) peptide of procollagen type III, matrix metalloproteinases (MMP-1, MMP-2,and MMP-9), and tissue inhibitors of MMPs were assayed.
Results: Left ventricular mass index and left atrial volume index were greater in patients with HF than those without HF (99.4±27.2g/m2 vs. 78.±22.4g/m2, p<0.005, and 69.4±25.5ml/m2 vs. 57.1±21.4ml/m2, p<0.05, respectively). Level of CITP was higher in patients with HF than those without it (8.8±5.8ng/ml vs. 5.3±1.8ng/ml, p<0.005). Similarly, level of PIIINP was elevated in patients with HF than those without it (10.9±3.4ng/ml vs. 8.0±2.9ng/ml, p<0.01). Prevalence of LGE was higher in patients with HF than those without it (58% versus 10%, p<0.0001). After multivariate analysis adjusting for age, gender, left ventricular mass, and cardiac chamber size, high level of CITP (p<0.05) and presence of LGE (p<0.05) remained correlated with HF.
Conclusions: Myocardial fibrosis correlates with HF in hypertensive patients. Noninvasive assessment of myocardial fibrosis with biomarkers and imaging technique, may assist the diagnosis and its therapeutic response.
- © 2011 by American Heart Association, Inc.