Extracellular Cardiac Matrix Biomarkers in Patients With Acute Myocardial Infarction Complicated by Left Ventricular Dysfunction and Heart Failure Insights From the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) Study
Extracellular Cardiac Matrix Biomarkers in Patients With Acute Myocardial Infarction Complicated by Left Ventricular Dysfunction and Heart Failure Insights From the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) Study
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DOI：
10.1161/circulationaha.108.809194
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发表时间：
2009-05-12
期刊：
影响因子：
37.8
通讯作者：
Zannad, Faiez
中科院分区：
文献类型：
--
作者：
Iraqi, Wafae;Rossignol, Patrick;Zannad, Faiez
背景--醛固酮刺激心脏胶原合成。循环胶原周转生物标记物为评估急性心肌梗死后充血性心力衰竭和左心室收缩功能不全患者的心脏重构提供了有用的工具。方法和结果-在一项关于依普利酮急性心肌梗死后心力衰竭疗效和存活研究(Ephesus)的子研究中，评估了选择性醛固酮受体拮抗剂依普利酮与安慰剂的疗效，对476例急性心肌梗死后充血性心力衰竭患者的血清胶原生物标志物水平进行了测定。I型胶原端肽和脑钠素水平高于基线中位数与全因死亡率和心血管死亡或心力衰竭住院的复合终点相关，风险比分别为2.49(P=0.039)和3.03(P=0.002)。在随访期间，依普利酮组的I型和III型前胶原氨基末端水平持续下降，从6个月开始显著下降。结论：胶原合成和降解的生物标志物的变化表明，细胞外基质重构是急性心肌梗死后充血性心力衰竭和左室收缩功能障碍患者的一个活跃过程。高I型胶原端肽和高脑钠素血清水平与最高的事件发生率相关。依普利酮抑制急性心肌梗死后胶原周转变化。(发行量。2009年；119：2471-2479。)
Background-Aldosterone stimulates cardiac collagen synthesis. Circulating biomarkers of collagen turnover provide a useful tool for the assessment of cardiac remodeling in patients with congestive heart failure and left ventricular systolic dysfunction after acute myocardial infarction.Methods and Results-In a substudy of the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS), which evaluated the effects of the selective aldosterone receptor antagonist eplerenone versus placebo, serum levels of collagen biomarkers were measured in 476 patients with congestive heart failure after acute myocardial infarction complicated with left ventricular systolic dysfunction. The combination of the type I collagen telopeptide and brain natriuretic peptide levels above median at baseline was associated with all-cause mortality and the composite end point of cardiovascular death or heart failure hospitalization, with hazard ratios of 2.49 (P = 0.039) and 3.03 (P = 0.002), respectively. During follow-up, levels of aminoterminal propeptide of type I and type III procollagen were found to be consistently lower in the eplerenone group and significantly lower beginning at 6 months.Conclusions-Changes in biomarkers of collagen synthesis and degradation suggest that extracellular matrix remodeling is an active process in patients with congestive heart failure and left ventricular systolic dysfunction after acute myocardial infarction. High type I collagen telopeptide and high brain natriuretic peptide serum levels are associated with the highest event rate. Eplerenone suppresses post-acute myocardial infarction collagen turnover changes. (Circulation. 2009; 119: 2471-2479.)