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Updated: Jul 16, 2025

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Biomarkers of Collagen Metabolism Are Associated with Left Ventricular Function and Prognosis in Dilated

Anne G Raafs1,2, Bouke P Adriaans1,2,3, Michiel T H M Henkens1,2,4,5

  • 1Department of Cardiology, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands.

Journal of Clinical Medicine
|September 9, 2023
PubMed

Insights

Collagen cross-linking in dilated cardiomyopathy (DCM) impacts heart function. Higher matrix metalloproteinase-1 (MMP-1) levels predict worse outcomes in DCM patients, while collagen cross-linking correlates with myocardial contraction.

Area of Science:

  • Cardiology
  • Biochemistry
  • Medical Research

Background:

  • Collagen cross-linking is a key process in dilated cardiomyopathy (DCM), contributing to disease progression and poorer prognosis.
  • Excessive collagen deposition over degradation in DCM leads to impaired cardiac function.

Purpose of the Study:

  • To investigate the relationship between collagen metabolism biomarkers and left ventricular function in DCM patients.
  • To assess the predictive value of these biomarkers for clinical outcomes in DCM.

Main Methods:

  • Included 209 DCM patients undergoing endomyocardial biopsy, blood sampling, and cardiac MRI.
  • Assessed primary endpoint of death, heart failure hospitalization, or arrhythmias over a 6-year follow-up.
  • Analyzed collagen volume fraction, PICP, CITP, and MMP-1 levels and their ratios.

Main Results:

  • No significant association between collagen volume fraction, PICP, or CITP:MMP-1 ratio and cardiac function parameters.
  • CITP:MMP-1 ratio correlated with global longitudinal strain (GLS), indicating impaired contraction with lower ratios.
  • Higher MMP-1 levels independently predicted worse outcomes in DCM patients, with combined MMP-1 and PICP improving predictive models.

Conclusions:

  • Myocardial cross-linking, indicated by CITP:MMP-1, is linked to myocardial longitudinal contraction.
  • MMP-1 serves as an independent predictor of prognosis in patients with dilated cardiomyopathy.
Abstract

Keywords:
CITP/MMP-1cardiovascular magnetic resonancedilated cardiomyopathyfeature trackingfibrosisglobal longitudinal strain

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