Evaluation of the relationship between dyssynchrony and myocardial fibrosis markers in patients with cardiac resynchronization therapy
Evaluation of the relationship between dyssynchrony and myocardial fibrosis markers in patients with cardiac resynchronization therapy
AbstractAim: Dyssynchrony can be seen in some patients with heart failure. The goal of cardiac resynchronization therapy (CRT) is the correction of dyssynchrony. The correction of myocardial loading and remodel-ing prevents development of the myocardial fibrosis. The aim of this study is to evaluate myocardial fibrosis markers in patients with heart failure CRT applied and to assess the relationship between these markers and dyssynchrony.Material and Methods: Fifty one patients (ejection fraction (EF) ≤ % 35, QRS duration ≥130 msec) were included into the study. Electrocardiography (ECG), 6 minute walking test, and echocardiography were applied before and 6 months after CRT to all patients. Furthermore, Type I Collagen C-Terminal Propeptide (PICP), Type I Collagen C-Terminal Telopeptide (ICTP) levels and PICP/ICTP ratio were studied as myocardi-al fibrosis markers in blood samples.Results: It is observed that QRS was shortened after CRT (p=0.0001). Six minute walking distance was in-creased 6 months after CRT (p=0.0001). PICP level measured before CRT as 560.2 ± 300.4 µg/L while it is measured as 476,9±285,8 µg/L 6 months after CRT (p=0.004). PICP/ICTP ratio before and 6 months after CRT was 9.7 ± 10 and 37.1 ± 32.8 respectively (p=0.0001). It is determined a negative relationship between EF and PICP level and PICP / ICTP ratio (p=0.008, r = -0.37).Conclusion: Our results show that CRT reduces the left ventricular dyssynchrony and consequently leads to favor-able changes in myocardial fibrosis markers. Reducing the mechanical stresses on left ventricle and returning of consequent remodeling may be one of the important mechanisms in the prevention of cardiac fibrosis.
___
- 1. Mullens W, Tang WH, Grimm RA. Using echocardiography in cardiac resynchronization therapy. Am Heart J 2007;154:1011-20.
- 2. Hawkins NM, Pesrie MC, MacDonald MR, et al. Selecting patients for cardiac resynchronization therapy: electrical or mechanical dyssynchrony? Eur Heart J 2006;27:1270-81.
- 3. Bax JJ, Marwick TH, Molhoek SG. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with endstage heart failure before pacemaker implantation. Am J Cardiol 2003;92:1238-40.
- 4. Ghio S, Freemantle N, Scelsi L, et al. Long-term left ventricular reverse remodeling with cardiac resynchronization therapy: results from the CARE-HF trial. Eur J Heart Fail 2009;11:480-8.
- 5. Sunman H, Canpolat U, Yorgun H, et al. Association between reverse electrical remodeling and cardiac fibrosis markers in patients with cardiac resynchronization therapy. Turk Kardiyol Dern Ars 2018;46:84-91.
- 6. Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association. Eur Heart J 2013;34:2281-329.
- 7. Otto CM. Left and right ventricular systolic function. In: Otto CM, ed. Textbook of clinical echo-cardiography. 3rd ed. Philadelphia: WB Saunders 2004:131-65.
- 8. Pitzalis MV, Iacoviello M, Romito R. Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol 2002;40:1615-22.
- 9. Cazeau S, Bordachar P, Jauvert G. Echocardiographic modeling of cardiac dyssynchrony before and during multisite stimulation: a prospective study. Pacing Clin Electrophysiol 2003;26:137-43.
- 10. Bax JJ, Ansalone G, Breithardt OA. Echocardiographic evaluation of cardiac resynchroniza-tion therapy: ready for routine clinical use? A critical appraisal. J Am Coll Cardiol 2004;44:1-9.
- 11. Bax JJ, Molhoek SG, van Erven L. Usefulness of myocardial tissue Doppler echocardiog-raphy to evaluate left ventricular dyssynchrony before and after biventricular pacing in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2003;91:94-7.
- 12. Bax JJ, Bleeker GB, Marwick TH. Left ventricular dyssynchrony predicts response and prog-nosis after cardiac resynchronization therapy. J Am Coll Cardiol 2004; 44:1834-40.
- 13. Heart Failure Society of America (HFSA) practice guidelines. HFSA guidelines for manage-ment of patients with heart failure caused by left ventricular systolic dysfunction--pharmacological approaches. J Card Fail 1999;5:357-832.
- 14. Braunwald E, Ross J, Sonnenblick EH. Medical progress. Mechanisms of contraction of the nor-mal and failing heart. N Engl J Med 1967;277:794-800.
- 15. Alla F, Kearney-Schwartz A, Radauceanu A, et al. Early changes in serum markers of cardiac extrADEllular matrix turnover in patients with uncomplicated hypertension and type II diabetes. Eur J Heart Fail 2006; 8:147-53.
- 16. Bristow MR, Saxon LA, Boehmer J. Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350:2140-50.
- 17. Alla F, Kearney-Schwartz A, Radauceanu A, et al. Early changes in serum markers of cardiac extracellular matrix turnover in patients with uncomplicated hypertension and type II diabetes. Eur J Heart Fail 2006; 8:147-53.
- 18. Kass DA. Ventricular dyssynchrony and mechanisms of resynchronization therapy. Eur Heart J Suppl 2002; 4:23-30.
- 19. Díez J, Querejeta R, Lo´pez B, et al. Losartan-dependent regression of myocardial fibrosis is associated with reduction of left ventricular chamber stiffness in hypertensive patients. Circulation 2002; 105:2512-7.
- 20. Klappacher G, Franzen P, Haab D, et al. Measuring extracellular matrix turnover in the serum of patients with idiopathic or ischemic dilated cardiomyopathy and impact on diagnosis and prog-nosis. Am J Cardiol 1995; 75:913-8.
- 21. Garc´ıa-Bolao I, Lo´pez B, Mac´ıas A, et al. Impact of collagen type I turnover on the long-term response to cardiac resynchronization therapy. European Heart J 2008; 29:898-906.
- 22. Cleland JGF, Daubert JC, Erdmann E, et al. Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization therapy on morbidity and mortali-ty in heart failure (the CArdiac R Esynchronization-Heart Failure [CAREHF] Trial). N Eng J Med 2005;352:1539-49.
- 23. Stanciu AE, Vatasescu RG, Stanciu MM, et al. Cardiac resynchronization therapy in patients with chronic heart failure is associated with anti-inflammatory and anti-remodeling effects. Clinical Biochemistry 2013; 46:230-4.