Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
Can J Cardiol. 2012 Jan-Feb;28(1):62-8. doi: 10.1016/j.cjca.2011.09.007. Epub 2011 Nov 21.
The differences in concentrations of biomarkers between heart failure (HF) patients with a preserved left ventricular ejection fraction (LVEF), or HF-PEF, and patients with HF with reduced LVEF (HF-REF) have yet to be defined. The objectives of this study were to compare the concentrations and correlation of biomarkers of inflammation, extracellular matrix (ECM) turnover and neurohormonal activation between these populations.
We performed a cross-sectional study of 29 subjects with symptomatic HF-REF (LVEF = 25.6 ± 5.1%) and 29 subjects with symptomatic HF-PEF (LVEF = 63.3 ± 5.3%). Concentrations of N-terminal proB-type natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein (hsCRP), procollagen type III amino-terminal peptide (PIIINP), matrix metalloproteinase (MMP)-2, MMP-9, and tissue inhibitor of MMP (TIMP)-1 were measured.
Although NT-proBNP and PIIINP concentrations were higher in patients with HF-REF compared with patients with HF-PEF (both P < 0.05), the only significant difference between the groups remaining after adjusting for possible confounding variables was NT-proBNP (P = 0.02). In patients with HF-REF, NT-proBNP correlated with PIIINP (P < 0.05), TIMP-1 (P < 0.05), and MMP-2 (P = 0.002), while PIIINP correlated with TIMP-1 (P < 0.05) and MMP-2 (P < 0.0001). In patients with a HF-PEF, only high sensitivity C-reactive protein correlated significantly with MMP-2 (P = 0.002).
Patients with HF-REF or HF-PEF presenting similar symptoms and functional limitations exhibit similar concentrations of biomarkers of ECM and inflammation. However, patients with HF-REF exhibit significantly higher NT-proBNP concentrations than patients with HF-PEF. The differences in the correlations observed between the biomarkers between these 2 populations suggest some heterogeneity and differences in the mechanisms related to the release or clearance of biomarkers in HF-REF vs HF-PEF.
心力衰竭（HF）患者左心室射血分数保留（HF-PEF）和射血分数降低（HF-REF）之间的生物标志物浓度差异尚未明确。本研究旨在比较这两种人群的炎症、细胞外基质（ECM）转化和神经激素激活的生物标志物浓度和相关性。
我们对 29 例有症状的 HF-REF 患者（LVEF=25.6±5.1%）和 29 例有症状的 HF-PEF 患者（LVEF=63.3±5.3%）进行了横断面研究。测量了 N 末端脑钠肽前体（NT-proBNP）、高敏 C 反应蛋白（hsCRP）、III 型前胶原氨基末端肽（PIIINP）、基质金属蛋白酶（MMP）-2、MMP-9 和基质金属蛋白酶组织抑制剂（TIMP）-1 的浓度。
尽管 HF-REF 患者的 NT-proBNP 和 PIIINP 浓度高于 HF-PEF 患者（均 P<0.05），但在调整可能的混杂因素后，两组之间仍存在显著差异的唯一标志物是 NT-proBNP（P=0.02）。在 HF-REF 患者中，NT-proBNP 与 PIIINP（P<0.05）、TIMP-1（P<0.05）和 MMP-2（P=0.002）相关，而 PIIINP 与 TIMP-1（P<0.05）和 MMP-2（P<0.0001）相关。在 HF-PEF 患者中，仅 hsCRP 与 MMP-2 显著相关（P=0.002）。
表现出相似症状和功能限制的 HF-REF 或 HF-PEF 患者表现出相似的 ECM 和炎症生物标志物浓度。然而，HF-REF 患者的 NT-proBNP 浓度明显高于 HF-PEF 患者。这两种人群之间观察到的生物标志物相关性差异表明，HF-REF 与 HF-PEF 之间与生物标志物释放或清除相关的机制存在一些异质性和差异。
