Episodes of Acute Heart Failure Syndrome Are Associated With Increased Levels of Troponin and Extracellular Matrix Markers

Abstract

Background-Increased myocyte loss and extracellular matrix (ECM) turnover are central mechanisms that contribute to pathological myocardial remodeling in chronic heart failure (HF). We tested the hypothesis that episodes of acute HF syndrome (AHFS) are associated with transient increases in markers of myocyte injury and ECM turnover beyond those observed in chronic stable HF. Methods and Results-Markers of myocyte injury and ECM turnover were assessed in 80 patients prospectively divided into 3 groups: AHFS (nϭ39); chronic stable systolic HF (nϭ21); and control subjects without HF (nϭ20). Myocyte injury was assessed by measuring plasma troponin I. ECM turnover was assessed by measuring plasma matrix metalloproteinases, tissue inhibitors of matrix metalloproteinases, and procollagen N-terminal type I and procollagen type III N-terminal peptides. In the AHFS group, biomarkers were obtained (1) at the time of hospital admission for an episode of HF decompensation, (2) at the time of hospital discharge, and (3) several weeks after discharge in patients who had returned to a chronic stable compensated state. In patients with stable HF (versus non-HF controls), there was a small increase in troponin I and little or no difference in any marker of ECM turnover. In patients with AHFS, troponin I and 3 markers of ECM turnover (matrix metalloproteinases-2, tissue inhibitors of matrix metalloproteinases-1, and procollagen type III N-terminal peptides) were elevated (versus chronic stable HF), and all fell toward chronic HF levels in patients who returned to a compensated state. Conclusion-Episodes

Serial Measurement of High-Sensitivity Cardiac Troponin I and N-Terminal proB-Type Natriuretic Peptide in a Patient Presenting with Cardiac Sarcoidosis

“…Theoretically, NT-proBNP is a marker of myocardial load and HscTnI is a marker of myocyte injury. Therefore, combined measurement of cardiac troponin and BNP can identify high risk patients and sometimes a discrepancy is seen between the two markers during the treatment period (6)(7)(8).…”

Heart Remodelation: Role of MMPs

“…The increase in ECM turnover may be associated with an acceleration of pathological remodeling. The decrease in the concentrations of MMP-2 during the acute phase of heart failure may represent the deceleration of myocardial remodeling and maybe a better prognosis of AHF [22]. In the study of Shirakabe et al, the serum levels of MMP-2 were measured on 83 AHF patients before starting treatment (day 1), on day 3 and day 7 after admission to the hospital, and before discharge.…”

Biomarkers in Acute Decompensated Heart Failure

“…107 Troponin-T has less frequently been utilized as an adjunctive biomarker in the diagnosis of HF, though several factors favor its utilization in the context of HF. cTnT is associated with not only LV end diastolic pressure, diastolic parameters, ejection fraction, pulmonary pressures [108][109][110][111] but also physical exam findings in acute HF, including an S3 gallop and pulmonary rales, 112 and clinical decongestion is associated with clearance of elevated troponins. 111,113 There are several limitations to cTnT in this context.…”

“…cTnT is associated with not only LV end diastolic pressure, diastolic parameters, ejection fraction, pulmonary pressures [108][109][110][111] but also physical exam findings in acute HF, including an S3 gallop and pulmonary rales, 112 and clinical decongestion is associated with clearance of elevated troponins. 111,113 There are several limitations to cTnT in this context. Although troponin elevations are seen in ADHF, 79,114 the differential diagnosis for elevations in troponin levels is broad and includes, primarily, acute coronary syndromes, pulmonary embolism, stroke, tachyarrhythmias, sepsis, or shock, among several others, which limits the specificity of the biomarker for any particular diagnosis.…”