Background: In patients with heart failure cardiac resynchronization therapy (CRT) leads to reverse ventricular remodelling. Aim: To evaluate whether myocardial collagen metabolism in patients with heart failure is implicated in adverse ventricular remodelling and response to CRT. Methods: Collagen synthesis and degradation were assessed from the concentrations of aminoterminal propeptides of type I and type III collagen (PINP and PIIINP) and carboxyterminal telopeptide of type I collagen (ICTP), respectively, in serum of 64 patients with heart failure before and after 6 months of CRT. Forty-six patients (72%) showed a > 10% reduction in LV end-systolic volume at follow-up and were classified as responders to CRT, the other 18 patients (28%) were classified as non-responders. Results: Responders demonstrated a mean (± SEM) increase of serum PINP and PIIINP during follow-up, from 32.9 ± 2.2 to 46.7 ± 4.0 μg/L (p < 0.001) and from 4.59 ± 0.24 to 5.13 ± 0.36 μg/L (p < 0.05), respectively. In non-responders, serum PINP and PIIINP remained unchanged during follow-up. At baseline, responders had significantly lower serum PINP than non-responders (32.9 ± 2.2 vs. 41.8 ± 4.3 μg/L; p < 0.05). ICTP levels of responders at baseline tended to be higher than in non-responders (3.54 ± 0.56 vs. 2.08 ± 0.37 μg/L, p = ns), and in both groups ICTP levels did not change upon CRT. Conclusion: Reverse LV remodelling following CRT is associated with increased collagen synthesis rate in the first 6 months of follow-up. © 2008 European Society of Cardiology.
Umar, S., Bax, J. J., Klok, M., van Bommel, R. J., Hessel, M. H. M., den Adel, B., … van der Laarse, A. (2008). Myocardial collagen metabolism in failing hearts before and during cardiac resynchronization therapy. European Journal of Heart Failure, 10(9), 878–883. https://doi.org/10.1016/j.ejheart.2008.06.019