Diagnosis of heart failure with preserved ejection fraction: improved accuracy with the use of markers of collagen turnover
Diagnosis of heart failure with preserved ejection fraction: improved accuracy with the use of markers of collagen turnover
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DOI：
10.1093/eurjhf/hfn036
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发表时间：
2009-02-01
影响因子：
18.2
通讯作者：
McDonald, Kenneth
中科院分区：
文献类型：
--
作者：
Martos, Ramon;Baugh, John;McDonald, Kenneth
射血分数保留性心力衰竭（HF-PEF）在临床实践中很难诊断。心肌纤维化是舒张功能障碍（DD）的主要决定因素，可能导致HF-PEF的进展。本研究的目的是分析胶原蛋白周转的血清学标志物是否可以预测HF-PEF和DD。我们纳入了85例白人治疗的高血压患者（DD n = 65; DD和HF-PEF n = 32）。测定血清羧基（PICP），氨基（PINP），和羧基端（CITP）肽的前胶原I型，氨基（PIIINP）肽的前胶原III型，基质金属蛋白酶（MMP-1，MMP-2和MMP-9），和MMP的组织抑制剂水平。采用受试者工作特征曲线分析，MMP-2（AUC = 0.91; 95%CI：0.84，0.98），CITP（0.83; 0.72，0.92），PICP（0.82; 0.72，0.92）、B型利钠肽（BNP）（0.82; 0.73，0.91）、MMP-9（0.79; 0.68，0.89）和PIIINP（0.78; 0.66，0.89）水平是HF-PEF的显著预测因素（均P < 0.01）。Ⅰ型前胶原羧基端肽（AUC = 0.74; 95% CI：0.62，0.86），MMP-2（0.73; 0.62，0.84），PIIINP BNP（0.69; 0.55，0.83）和PICP（0.66; 0.54，0.78）水平是DD的显著预测因素（均P < 0.05）。MMP-2的1585 ng/mL的截止值为预测HF-PEF提供了91%的灵敏度和76%的特异性，并且生物标志物的组合可用于调整灵敏度或特异性。基质金属蛋白酶2在HF-PEF的鉴别诊断中可能比BNP更有价值。这表明，这些新的生化工具可能有助于识别患有这些诊断挑战性疾病的患者。
Heart failure with preserved ejection fraction (HF-PEF) can be difficult to diagnose in clinical practice. Myocardial fibrosis is a major determinant of diastolic dysfunction (DD), potentially contributing to the progression of HF-PEF. The aim of this study was to analyse whether serological markers of collagen turnover may predict HF-PEF and DD.We included 85 Caucasian treated hypertensive patients (DD n = 65; both DD and HF-PEF n = 32). Serum carboxy (PICP), amino (PINP), and carboxytelo (CITP) peptides of procollagen type I, amino (PIIINP) peptide of procollagen type III, matrix metalloproteinases (MMP-1, MMP-2, and MMP-9), and tissue inhibitor of MMP levels were assayed. Using receiver operating characteristic curve analysis, MMP-2 (AUC = 0.91; 95% CI: 0.84, 0.98), CITP (0.83; 0.72, 0.92), PICP (0.82; 0.72, 0.92), B-type natriuretic peptide (BNP) (0.82; 0.73, 0.91), MMP-9 (0.79; 0.68, 0.89), and PIIINP (0.78; 0.66, 0.89) levels were significant predictors of HF-PEF (P < 0.01 for all). Carboxytelo peptides of procollagen type I (AUC = 0.74; 95% CI: 0.62, 0.86), MMP-2 (0.73; 0.62, 0.84), PIIINP (0.73; 0.60, 0.85), BNP (0.69; 0.55, 0.83) and PICP (0.66; 0.54, 0.78) levels were significant predictors of DD (P < 0.05 for all). A cutoff of 1585 ng/mL for MMP-2 provided 91% sensitivity and 76% specificity for predicting HF-PEF and combinations of biomarkers could be used to adjust either sensitivity or specificity.Markers of collagen turnover identify patients with HF-PEF and DD. Matrix metalloproteinase 2 may be more useful than BNP in the identification of HF-PEF. This suggests that these new biochemical tools may assist in identifying patients with these diagnostically challenging conditions.