Clinical InvestigationCongestive Heart FailureSerum markers of deranged myocardial collagen turnover: Their relation to malignant ventricular arrhythmias in cardioverter-defibrillator recipients with heart failure
Section snippets
Patient selection
The initially assessed study population consisted of 84 patients with clinically stable heart failure, due either to idiopathic dilated cardiomyopathy (n = 39) or coronary artery disease (n = 45) and an ICD. Patients with angina or signs of significant ischemia, as assessed by thallium scintigraphy or coronary angiography, were not included. Conditions known to alter collagen turnover or inflammatory status, such as renal impairment, liver disease, history of atrial fibrillation, pulmonary
Patient characteristics
During the 1-year follow-up, fast ventricular arrhythmias related to unstable angina or to heart failure deterioration were observed in 4 patients with dilated cardiomyopathy and in 6 with coronary artery disease; thus, these 10 patients were not included in the analysis. The data of the remaining 74 patients were eventually analyzed. No patient died or withdrew during the study period. Their baseline characteristics are depicted in Table I.
Arrhythmic episodes and collagen turnover markers
During the follow-up period, appropriate device
Main findings
In this study, we have shown that, in stable patients with heart failure and an ICD, the biochemical markers indicative of specific derangements in the balance of collagens I and III synthesis as well as in the equilibrium of myocardial deposition and degradation are related to the frequency of ensuing malignant ventricular arrhythmias, occurring in the 12-month period after ICD implantation. These indexes seem to be related to arrhythmic episodes as strongly as ejection fraction.
Fibrosis and ventricular arrhythmias
Several
References (27)
- et al.
ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices)
J Am Coll Cardiol
(2008) - et al.
Dilated cardiomyopathy is associated with an increase in the type I/type III collagen ratio: a quantitative assessment
J Am Coll Cardiol
(1995) - et al.
Left and right ventricular collagen type I/III ratios and remodeling post-myocardial infarction
J Card Fail
(1999) - et al.
Measuring extracellular matrix turnover in the serum of patients with idiopathic or ischemic dilated cardiomyopathy and impact on diagnosis and prognosis
Am J Cardiol
(1995) - et al.
Recommendations for chamber quatification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005) - et al.
Myocardial fibrosis predicts appropriate device therapy in patients with implantable cardioverter-defibrillators for primary prevention of sudden cardiac death
J Am Coll Cardiol
(2011) - et al.
Matrix metalloproteinases and tissue remodeling in hypertrophoc cardiomyopathy
Am Heart J
(2008) - et al.
Plasma MMP-2, MMP-9 and N-BNP in long-term survivors following complicated myocardial infarction: relation to cardiac magnetic resonance imaging measures of left ventricular structure and function
J Card Fail
(2007) - et al.
Serum markers of collagen turnover predict future shocks in implantable cardioverter-defibrillator recipients with dilated cardiomyopathy on optimal treatment
J Am Coll Cardiol
(2010) - et al.
Assessment of nonischemic myocardial fibrosis
J Am Coll Cardiol
(2010)