Diagnosis of heart failure with preserved ejection fraction: improved accuracy with the use of markers of collagen turnover.

Hdl Handle:
http://hdl.handle.net/10147/207551
Title:
Diagnosis of heart failure with preserved ejection fraction: improved accuracy with the use of markers of collagen turnover.
Authors:
Martos, Ramon; Baugh, John; Ledwidge, Mark; O'Loughlin, Christina; Murphy, Niamh F; Conlon, Carmel; Patle, Anil; Donnelly, Seamas C; McDonald, Kenneth
Affiliation:
Heart Failure Unit, School of Medicine and Medical Science, St Vincent's, University Hospital, Elm Park, Dublin 4, Ireland.
Citation:
Eur J Heart Fail. 2009 Feb;11(2):191-7.
Journal:
European journal of heart failure
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207551
DOI:
10.1093/eurjhf/hfn036
PubMed ID:
19168518
Abstract:
AIMS: Heart failure with preserved ejection fraction (HF-PEF) can be difficult to diagnose in clinical practice. Myocardial fibrosis is a major determinant of diastolic dysfunction (DD), potentially contributing to the progression of HF-PEF. The aim of this study was to analyse whether serological markers of collagen turnover may predict HF-PEF and DD. METHODS AND RESULTS: We included 85 Caucasian treated hypertensive patients (DD n=65; both DD and HF-PEF n=32). Serum carboxy (PICP), amino (PINP), and carboxytelo (CITP) peptides of procollagen type I, amino (PIIINP) peptide of procollagen type III, matrix metalloproteinases (MMP-1, MMP-2, and MMP-9), and tissue inhibitor of MMP levels were assayed. Using receiver operating characteristic curve analysis, MMP-2 (AUC=0.91; 95% CI: 0.84, 0.98), CITP (0.83; 0.72, 0.92), PICP (0.82; 0.72, 0.92), B-type natriuretic peptide (BNP) (0.82; 0.73, 0.91), MMP-9 (0.79; 0.68, 0.89), and PIIINP (0.78; 0.66, 0.89) levels were significant predictors of HF-PEF (P<0.01 for all). Carboxytelo peptides of procollagen type I (AUC=0.74; 95% CI: 0.62, 0.86), MMP-2 (0.73; 0.62, 0.84), PIIINP (0.73; 0.60, 0.85), BNP (0.69; 0.55, 0.83) and PICP (0.66; 0.54, 0.78) levels were significant predictors of DD (P<0.05 for all). A cutoff of 1585 ng/mL for MMP-2 provided 91% sensitivity and 76% specificity for predicting HF-PEF and combinations of biomarkers could be used to adjust either sensitivity or specificity. CONCLUSION: Markers of collagen turnover identify patients with HF-PEF and DD. Matrix metalloproteinase 2 may be more useful than BNP in the identification of HF-PEF. This suggests that these new biochemical tools may assist in identifying patients with these diagnostically challenging conditions.
Language:
eng
MeSH:
Aged; Biological Markers/blood; Collagen/*metabolism; Collagen Type I/blood; Collagen Type III/blood; Female; Heart Failure/*diagnosis/metabolism/physiopathology; Heart Failure, Diastolic/diagnosis; Humans; Male; Matrix Metalloproteinases/blood; Middle Aged; Peptides/blood; Sensitivity and Specificity; *Stroke Volume; Tissue Inhibitor of Metalloproteinase-1/blood
ISSN:
1388-9842 (Print); 1388-9842 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorMartos, Ramonen_GB
dc.contributor.authorBaugh, Johnen_GB
dc.contributor.authorLedwidge, Marken_GB
dc.contributor.authorO'Loughlin, Christinaen_GB
dc.contributor.authorMurphy, Niamh Fen_GB
dc.contributor.authorConlon, Carmelen_GB
dc.contributor.authorPatle, Anilen_GB
dc.contributor.authorDonnelly, Seamas Cen_GB
dc.contributor.authorMcDonald, Kennethen_GB
dc.date.accessioned2012-02-01T10:31:05Z-
dc.date.available2012-02-01T10:31:05Z-
dc.date.issued2012-02-01T10:31:05Z-
dc.identifier.citationEur J Heart Fail. 2009 Feb;11(2):191-7.en_GB
dc.identifier.issn1388-9842 (Print)en_GB
dc.identifier.issn1388-9842 (Linking)en_GB
dc.identifier.pmid19168518en_GB
dc.identifier.doi10.1093/eurjhf/hfn036en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207551-
dc.description.abstractAIMS: Heart failure with preserved ejection fraction (HF-PEF) can be difficult to diagnose in clinical practice. Myocardial fibrosis is a major determinant of diastolic dysfunction (DD), potentially contributing to the progression of HF-PEF. The aim of this study was to analyse whether serological markers of collagen turnover may predict HF-PEF and DD. METHODS AND RESULTS: We included 85 Caucasian treated hypertensive patients (DD n=65; both DD and HF-PEF n=32). Serum carboxy (PICP), amino (PINP), and carboxytelo (CITP) peptides of procollagen type I, amino (PIIINP) peptide of procollagen type III, matrix metalloproteinases (MMP-1, MMP-2, and MMP-9), and tissue inhibitor of MMP levels were assayed. Using receiver operating characteristic curve analysis, MMP-2 (AUC=0.91; 95% CI: 0.84, 0.98), CITP (0.83; 0.72, 0.92), PICP (0.82; 0.72, 0.92), B-type natriuretic peptide (BNP) (0.82; 0.73, 0.91), MMP-9 (0.79; 0.68, 0.89), and PIIINP (0.78; 0.66, 0.89) levels were significant predictors of HF-PEF (P<0.01 for all). Carboxytelo peptides of procollagen type I (AUC=0.74; 95% CI: 0.62, 0.86), MMP-2 (0.73; 0.62, 0.84), PIIINP (0.73; 0.60, 0.85), BNP (0.69; 0.55, 0.83) and PICP (0.66; 0.54, 0.78) levels were significant predictors of DD (P<0.05 for all). A cutoff of 1585 ng/mL for MMP-2 provided 91% sensitivity and 76% specificity for predicting HF-PEF and combinations of biomarkers could be used to adjust either sensitivity or specificity. CONCLUSION: Markers of collagen turnover identify patients with HF-PEF and DD. Matrix metalloproteinase 2 may be more useful than BNP in the identification of HF-PEF. This suggests that these new biochemical tools may assist in identifying patients with these diagnostically challenging conditions.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshBiological Markers/blooden_GB
dc.subject.meshCollagen/*metabolismen_GB
dc.subject.meshCollagen Type I/blooden_GB
dc.subject.meshCollagen Type III/blooden_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHeart Failure/*diagnosis/metabolism/physiopathologyen_GB
dc.subject.meshHeart Failure, Diastolic/diagnosisen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMatrix Metalloproteinases/blooden_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshPeptides/blooden_GB
dc.subject.meshSensitivity and Specificityen_GB
dc.subject.mesh*Stroke Volumeen_GB
dc.subject.meshTissue Inhibitor of Metalloproteinase-1/blooden_GB
dc.titleDiagnosis of heart failure with preserved ejection fraction: improved accuracy with the use of markers of collagen turnover.en_GB
dc.contributor.departmentHeart Failure Unit, School of Medicine and Medical Science, St Vincent's, University Hospital, Elm Park, Dublin 4, Ireland.en_GB
dc.identifier.journalEuropean journal of heart failureen_GB
dc.description.provinceLeinster-
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