Blangy Hugues, Sadoul Nicolas, Dousset Brigitte, Radauceanu Anca, Fay Renaud, Aliot Etienne, Zannad Faiez
Département de Cardiologie, CHU de Nancy, Hôpital de Brabois, Rue du Morvan, 54511, Vandoeuvre-lès-Nancy, France.
Europace. 2007 Sep;9(9):724-9. doi: 10.1093/europace/eum102. Epub 2007 May 24.
Ventricular arrhythmia is the main cause of sudden cardiac death. Intracardiac strain, myocardial and extracellular matrix remodelling, and subsequent myocardial fibrosis are involved in arrhythmia pathogenesis. The present study investigates the relationship between cardiac fibrosis [procollagen type I aminoterminal peptide (PINP), procollagen type III aminoterminal peptide (PIIINP), TIMP1, membrane metalloproteinase I], pressure overload [brain natriuretic peptide (BNP)] inflammation [high sensitivity (hs)-C-reactive protein] serum markers, and the incidence of ventricular tachycardia (VT) in implantable cardioverter-defibrillators (ICD) recipients.
Serum markers were collected in 121 patients implanted for spontaneous sustained VT and a prior history of myocardial infarction. VT incidence was obtained during ICD interrogation. Over a 1 year period, 38 patients (31%) experienced at least 1 VT. In a multivariate analysis, a left ventricular ejection fraction <0.35 (OR = 2.19, 95%CI 1.00-4.79, P = 0.049), an increased serum BNP (OR = 3.75, 95%CI 1.46-9.67, P = 0.014), an increased hs-C-reactive protein (OR = 3.2, 95%CI 1.26-8.10, P = 0.006), an increased PINP (OR = 3.71, 95%CI 1.40-9.88, P = 0.009), and a decreased PIIINP (OR = 0.21, 95%CI 0.08-0.59, P = 0.003) were associated with a higher VT incidence.
In coronary artery disease patients: (1) BNP is not only a marker of left ventricular dysfunction, but also a marker of VT; (2) combined 'high PINP and low PIIINP' is a strong VT marker; and 3) inflammatory process is involved in VT pathogenesis.
室性心律失常是心源性猝死的主要原因。心腔内应变、心肌及细胞外基质重塑以及随后的心肌纤维化参与心律失常的发病机制。本研究调查心脏纤维化[I型前胶原氨基端肽（PINP）、III型前胶原氨基端肽（PIIINP）、金属蛋白酶组织抑制因子1（TIMP1）、膜型金属蛋白酶1（MMP1）]、压力超负荷[脑钠肽（BNP）]、炎症[高敏（hs）-C反应蛋白]血清标志物与植入式心脏复律除颤器（ICD）植入者室性心动过速（VT）发生率之间的关系。
收集121例因自发性持续性VT植入且有心肌梗死病史患者的血清标志物。通过ICD问询获得VT发生率。在1年期间，38例患者（31%）发生至少1次VT。多因素分析显示，左心室射血分数<0.35（比值比[OR]=2.19,95%可信区间[CI]1.00-4.79,P=0.049）、血清BNP升高（OR=3.75,95%CI1.46-9.67,P=0.014）、hs-C反应蛋白升高（OR=3.2,95%CI1.26-8.10,P=0.006）、PINP升高（OR=3.71,95%CI1.40-9.88,P=0.009）以及PIIINP降低（OR=0.21,95%CI0.08-0.59,P=0.003）与较高的VT发生率相关。
在冠心病患者中：（1）BNP不仅是左心室功能障碍的标志物，也是VT的标志物；（2）“高PINP和低PIIINP”组合是强有力的VT标志物；（3）炎症过程参与VT发病机制。
