The correlation between serum ECM1 and cardiac fibrosis in heart failure patients

Chronic heart failure (HF) is characterized by progressive myocardial injury and remodeling. Extracellular matrix protein 1 (ECM1) and low-density lipoprotein receptor-related protein 1 (LRP1) have been implicated in fibrosis; however, their clinical significance in HF remains unclear. This study aimed to investigate the relationship between circulating ECM1 and LRP1 levels and cardiac dysfunction and fibrosis markers in patients with chronic HF.

We conducted a cross-sectional study of 93 patients with chronic HF (LVEF ≤ 50%) and 80 age- and sex-matched controls with stable cardiovascular disease (LVEF > 50%). Clinical data, routine biochemical parameters, and echocardiography images were obtained. Serum ECM1, LRP1, TGF-β1, CTGF, and PICP levels were measured using ELISA. Statistical analyses included group comparisons, receiver operating characteristic (ROC) curve analysis, and Spearman's correlation with Bonferroni adjustment for multiple testing.

Patients with HF had significantly higher serum ECM1 (157.3 ± 28.4 vs. 92.8 ± 14.7 pg/mL) and LRP1 (14.3 ± 2.6 vs. 8.7 ± 1.3 µg/mL) levels than controls (both P < 0.001). ROC analysis showed that ECM1 discriminated HF from non-HF patients with an AUC of 0.985, sensitivity of 91.4%, and specificity of 98.7%. Both ECM1 and LRP1 levels increased with worsening NYHA class. ECM1 was negatively correlated with LVEF and positively correlated with CK-MB, NT-proBNP, TGF-β1, CTGF, PICP, and LRP1. LRP1 expression was also correlated with LVEF, CK-MB, NT-proBNP, and fibrosis marker levels.

Circulating ECM1 and LRP1 levels are elevated in chronic HF and are closely associated with cardiac dysfunction and fibrosis. These findings suggest that ECM1 and LRP1 could serve as novel biomarkers for myocardial remodeling, with potential utility in the risk stratification and monitoring of patients with HF.