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Updated: Dec 13, 2025

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Matrix Metalloproteinases Increase Because of Hypoperfusion in Obstructive Hypertrophic Cardiomyopathy

Xuanye Bi1, Chengzhi Yang1, Yunhu Song1

  • 1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

The Annals of Thoracic Surgery
|August 2, 2020
PubMed
Abstract

Insights

In hypertrophic cardiomyopathy, high plasma ratios of PICP/ICTP and MMP-2/TIMP-1 predict adverse cardiovascular outcomes. These biomarkers indicate poor prognosis in patients with obstructive hypertrophic cardiomyopathy.

Area of Science:

  • Cardiology
  • Biomarkers
  • Pathophysiology

Background:

  • Myocardial fibrosis (MF) is linked to microvascular dysfunction in hypertrophic cardiomyopathy.
  • Matrix metalloproteinases (MMPs) and tissue inhibitors (TIMPs) influence collagen degradation and MF development.

Purpose of the Study:

  • Investigate relationships between MF, microvascular rarefaction, and MMPs.
  • Assess prognostic value of MF-related circulating biomarkers in obstructive hypertrophic cardiomyopathy (HOCM).

Main Methods:

  • Analyzed myocardial samples from 55 HOCM patients post-surgery for fibrosis and microvascular density.
  • Measured myocardial and plasma levels of MMP-2, MMP-9, TIMP-1, PICP, and ICTP.
  • Assessed composite cardiovascular endpoints over 44-month follow-up.

Main Results:

  • Microvascular density correlated with myocardial MMP-2/TIMP-1 ratio (r = -0.348, P = .009).
  • Plasma PICP/ICTP and MMP-2/TIMP-1 ratios were strong prognostic markers.
  • High plasma PICP/ICTP and MMP-2/TIMP-1 ratios independently predicted adverse cardiovascular outcomes (HRs 12.683 and 17.037).

Conclusions:

  • Myocardial MMP-2/TIMP-1 ratio elevation in HOCM may stem from microvascular rarefaction, not directly causing MF.
  • Elevated plasma PICP/ICTP and MMP-2/TIMP-1 ratios are independent predictors of adverse outcomes in HOCM patients.

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