Petrovic Ivana, Stankovic Ivan, Milasinovic Goran, Nikcevic Gabrijela, Kircanski Bratislav, Jovanovic Velibor, Raspopovic Srdjan, Radovanovic Nikola, Pavlovic Sinisa U
School of Medicine, University of Belgrade, Belgrade, Serbia.
Department of Cardiology, University Clinical Hospital Centre Zemun, Belgrade, Serbia.
J Med Biochem. 2016 Apr;35(2):130-136. doi: 10.1515/jomb-2016-0001. Epub 2016 May 9.
In the majority of patients with a wide QRS complex and heart failure resistant to optimal medical therapy, cardiac resynchronization therapy (CRT) leads to reverse ventricular remodeling and possibly to changes in cardiac collagen synthesis and degradation. We investigated the relationship of biomarkers of myocardial collagen metabolism and volumetric response to CRT.
We prospectively studied 46 heart failure patients (mean age 61±9 years, 87% male) who underwent CRT implantation. Plasma concentrations of amino-terminal propeptide type I (PINP), a marker of collagen synthesis, and carboxy-terminal collagen telopeptide (CITP), a marker of collagen degradation, were measured before and 6 months after CRT. Response to CRT was defined as 15% or greater reduction in left ventricular end-systolic volume at 6-month follow-up.
Baseline PINP levels showed a negative correlation with both left ventricular end-diastolic volume (r=-0.51; p=0.032), and end-systolic diameter (r=-0.47; p=0.049). After 6 months of device implantation, 28 patients (61%) responded to CRT. No significant differences in the baseline levels of PINP and CITP between responders and nonresponders were observed (p>0.05 for both). During follow-up, responders demonstrated a significant increase in serum PINP level from 31.37±18.40 to 39.2±19.19 μg/L (p=0.049), whereas in non-responders serum PINP levels did not significantly change (from 28.12±21.55 to 34.47± 18.64 μg/L; p=0.125). There were no significant changes in CITP levels in both responders and non-responders (p>0.05).
Left ventricular reverse remodeling induced by CRT is associated with an increased collagen synthesis in the first 6 months of CRT implantation.
在大多数QRS波群增宽且对最佳药物治疗耐药的心力衰竭患者中，心脏再同步治疗（CRT）可导致心室逆向重构，并可能引起心脏胶原合成与降解的变化。我们研究了心肌胶原代谢生物标志物与CRT容积反应之间的关系。
我们前瞻性地研究了46例接受CRT植入的心力衰竭患者（平均年龄61±9岁，87%为男性）。在CRT植入前及植入后6个月测量血浆I型前胶原氨基端前肽（PINP，一种胶原合成标志物）和羧基端胶原肽（CITP，一种胶原降解标志物）的浓度。CRT反应定义为在6个月随访时左心室收缩末期容积减少15%或更多。
基线PINP水平与左心室舒张末期容积（r=-0.51；p=0.032）和收缩末期直径（r=-0.47；p=0.049）均呈负相关。装置植入6个月后，28例患者（61%）对CRT有反应。反应者与无反应者的PINP和CITP基线水平无显著差异（两者p>0.05）。随访期间，反应者血清PINP水平从31.37±18.40显著升高至39.2±19.19μg/L（p=0.049），而无反应者血清PINP水平无显著变化（从28.12±21.55至34.47±18.64μg/L；p=0.125）。反应者和无反应者的CITP水平均无显著变化（p>0.05）。
CRT诱导的左心室逆向重构与CRT植入后最初6个月内胶原合成增加有关。
