Relationship Between the Biomarkers of Collagen Regulation and Echocardiography Parameters in Patients With Heart
N E Shirokov1, T N Enina1, E V Zueva1
1Tyumen Cardiological Research Center, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk.
Insights
Heart failure with preserved ejection fraction (HFpEF) patients show strong links between collagen markers and echocardiography findings. These relationships highlight collagen homeostasis disorders in HFpEF, impacting left ventricular filling pressure.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Imaging
Background:
- Heart failure with preserved ejection fraction (HFpEF) diagnosis can be challenging.
- Diastolic stress testing (DST) aids in assessing left ventricular (LV) diastolic function.
- Understanding the interplay between laboratory markers and echocardiography (EchoCG) is crucial for HFpEF management.
Purpose of the Study:
- To investigate the associations between specific laboratory markers and EchoCG parameters in HFpEF.
- To evaluate these relationships in the context of diastolic stress test (DST) results.
- To identify key biomarkers reflecting collagen homeostasis and their correlation with diastolic dysfunction.
Main Methods:
- Patients were selected based on current guidelines for LV diastolic function assessment.
- Diastolic stress testing (DST) was employed when resting EchoCG was inconclusive for elevated LV filling pressure (FP).
- Concentrations of immune inflammation, endothelial dysfunction, collagen homeostasis, and myocardial stress markers were measured in 80 patients (41 with positive DST, 39 with negative DST).
Main Results:
- Significant differences in E/e' ratio and diastolic functional reserve index (DFRI) were observed between DST groups.
- Resting EchoCG showed significant differences in left atrial reservoir strain (LASr) and left atrial stiffness index (LASI).
- Collagen regulation markers, particularly N-terminal propeptide of procollagen type I (PINP), exhibited numerous correlations with EchoCG parameters (LAVI, DFRI) and other biomarkers (IL-10, myeloperoxidase) in HFpEF patients.
Conclusions:
- HFpEF patients demonstrate a substantial number of correlations between collagen homeostasis markers and EchoCG parameters.
- These findings underscore the role of collagen dysregulation in elevated LV filling pressure characteristic of HFpEF.
- Laboratory markers of collagen turnover provide valuable insights into the pathophysiology of HFpEF.
Aim:
To study the relationship between laboratory markers and echocardiography (EchoCG) parameters in heart failure with preserved ejection fraction (HFpEF) depending on the results of the diastolic stress test (DST).
Material And Methods:
The diagnostic algorithm provided by the current guidelines for the assessment of left ventricular (LV) diastolic function was used to select patients. If there were not enough criteria to make a conclusion about increased LV filling pressure (FP) based on standard resting echocardiography data in patients with arterial hypertension and ischemic heart disease, DST was performed to detect HFpEF. 80 patients (50.0% men, mean age 66.3±5.4 years) were included. Group 1 consisted of 41 patients with a positive DST, and group 2 included 39 patients with a negative DST. Concentrations of the markers of immune inflammation, endothelial dysfunction, collagen homeostasis, and myocardial stress were measured.
Results:
The DST showed significant differences in the E/e' ratio (15.1 [13.4; 15.9] in group 1 and 9.5 [7.9; 10.3] in group 2, respectively, p<0.001) and the diastolic functional reserve index (DFRI) (9.8 [6.8; 14.0] and 21.0 [13.0; 29.0], p < 0.001). Resting EchoCG revealed significant differences in the left atrial reservoir strain (LASr) (22.8 [19.6; 25.6]% and 28.0 [24.8; 30.2]%, p<0.001) and the left atrial stiffness index (LASI) (0.50 [0.40; 0.57] and 0.34 [0.27; 0.41], p<0.001). In patients with HFpEF, the laboratory parameters of collagen regulation had the greatest number of relationships. Correlations were found between the concentrations of matrix metalloproteinase-9 and other biomarkers, including interleukin-10 (IL-10) (r=0.311; p=0.048), myeloperoxidase (r=0.382; p=0.014), N-terminal propeptide of procollagen type I (procollagen I N-terminal propeptide, PINP) (r=0.722; p<0.001) and type III (r=0.591; p<0.001), C-terminal propeptide of procollagen type I (r=0.330; p=0.035), tissue inhibitor of metalloproteinases type 1 (r=0.410; p=0.008), EchoCG parameters, including left atrial volume index (LAVI) (r=0.414; p=0.007) and DFRI (r=0.354; p=0.025). In addition, correlations were found for the concentrations of PINP with IL-10 (r=0.401; p=0.009) and endothelin-1 (r= -0.337; p=0.031); PINP with LAVI (r=0.498; p=0.001) and DFRI (r=0.420; p=0.007).
Conclusion:
Patients with HFpEF have a greater number of relationships between markers of collagen homeostasis disorders and EchoCG parameters characterizing an increase in LV FP.
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