Mechanical circulatory supportPlasma Biomarkers of Myocardial Fibrosis and Remodeling in Terminal Heart Failure Patients Supported by Mechanical Circulatory Support Devices
Section snippets
Patient Population
We analyzed plasma samples of 40 blood donors and 55 patients with deteriorating HF and need for MCS. Forty of the MCS patients were supported by a VAD and 15 by a TAH. Left ventricular end-diastolic diameter (LVEDD) and ejection fraction (EF), respectively, at the time of MCS device implantation were as follows (mean ± SD): VAD patients, 72.5 ± 9.4 mm and 26.2 ± 11.1%; and TAH patients, 65 ± 11.3 mm and 23.5 ± 17.9%. See Table 1 for abbreviations and detailed clinical data. TAH implantation
B-type Natriuretic Peptide
Natriuretic peptide BNP is released by the myocardium upon mechanical stress.11 In control samples from blood donors we observed a plasma concentration (mean ± SD) of 17.4 ± 14.6 pg/ml. At the time of VAD or TAH implantation we detected levels of 1,663 ± 1,627 pg/ml and 2,151 ± 2,431 pg/ml, respectively. Mechanical unloading of the heart or removal of the failing ventricles reduced plasma concentrations to 438.6 ± 501.4 pg/ml in VAD patients and to 311.8 ± 259.1 pg/ml in TAH recipients (Figure 1
Discussion
Impaired myocardial collagen turnover is associated with cardiac remodeling and HF. Structural reshaping of the myocardium is mainly controlled by the activity of MMPs and TIMPs. The failing heart displays an increased expression of MMP-2, TIMP1 and TIMP4 on mRNA and protein level.21, 22, 23 In addition, it has been found that plasma concentrations of MMP-2 and TIMP1 are correlated with the severity of HF, as defined by the classication of the New York Heart Association (NYHA),13, 24, 25 and
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2023, Advances in Clinical ChemistryCitation Excerpt :It has also been reported as a marker of interstitial fibrosis, albeit less responsive to loading and unloading [93]. In support of this theory, Milting et al. have shown that unloading of poorly contractile hearts with assist devices causes a significant decrease in various neurohormones including natriuretic peptides, but not galectin-3 [94]. It has been recognized that galectin-3 is extremely useful for detecting early stage disease [95].
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2018, HeliyonCitation Excerpt :A contemporary study suggests that at 2 months serum BNP levels ≤322 pg/ml are significantly associated with all-cause mortality [33]. Yet the challenge and limitation at this time is that mechanical unloading in LVAD recipients is not associated with a rapid reduction of standard plasma biomarkers [34]. Additional investigation is required to determine if CARP could serve as a biomarker of ventricular unloading and if the changes occur in a dynamic and rapid fashion in the majority of patients.
The first two authors (H.M. and P.E.) contributed equally to this work.