Alterations in the pattern of collagen deposition may contribute to the deterioration of systolic function in hypertensive patients with heart failure
Alterations in the pattern of collagen deposition may contribute to the deterioration of systolic function in hypertensive patients with heart failure
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DOI：
10.1016/j.jacc.2006.01.077
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发表时间：
2006-07-04
影响因子：
24
通讯作者：
Diez, Javier
中科院分区：
文献类型：
--
作者：
Lopez, Begona;Gonzalez, Arantxa;Diez, Javier
我们试图评估胶原沉积和胶原降解的分布在高血压患者无论是收缩性心力衰竭（SHF）或舒张性心力衰竭（DHF）。背景增加胶原合成和沉积已被描述在心肌心力衰竭（HF）高血压patients.METHODS我们研究了39 HF高血压患者分为两组：16与SHF和23与DHF。进行肌内膜活检以定量mysial（即，肌周加肌内膜）和血管周和瘢痕相关胶原体积分数（CV-F）。结果SHF高血压患者心肌CVF明显低于正常血压组（p < 0.05）和DHF高血压组（p < 0.01）;两组高血压患者血管周围和瘢痕相关CVF均高于正常血压者（p < 0.05），SHF高血压患者高于DHF高血压患者（p < 0.05）。与其他两组受试者相比，来自SHF高血压组的组织和血清样品中MMP-1：TIMP-1比率增加（p < 0.05）。MMP-1在SHF高血压患者心肌细胞和平滑肌细胞中的表达明显高于DHF高血压患者和正常血压者（P < 0.01）。血清MMP-1/TIMP-1比值与射血分数呈负相关（r =-0.510，p <0.001），与左室舒张末期内径呈正相关（r = 0.549，p < 0.001）。提示心肌胶原过度降解可能与HF高血压患者收缩功能受损有关。
OBJECTIVES We sought to assess the distribution of collagen deposits and collagen degradation in hypertensive patients with either systolic heart failure (SHF) or diastolic heart failure (DHF).BACKGROUND Increased collagen synthesis and deposition have been described in the myocardium of heart failure (HF) hypertensive patients.METHODS We studied 39 HF hypertensive patients subdivided into two groups: 16 with SHF and 23 with DHF. Endomyocardial biopsies were performed to quantify mysial (i.e., perimysial plus endomysial) and perivascular and scar-related collagen volume fraction (CV-F). Matrix metalloproteinase (MMP)-1 and its tissue inhibitor matrix metalloproteinase (TIMP)-1 were analyzed in cardiac samples by Western blot and immunohistochemistry, and in blood samples by enzyme-linked immunosorbent assay.RESULTS Mysial CVF was lower in SHF hypertensive patients than in normotensive (p < 0.05) and DHF hypertensive patients (p < 0.01). Perivascular and scar-related CVF was higher (p < 0.05) in the two groups of hypertensive patients than in normotensive subjects, and in SHF hypertensive compared with DHF hypertensive patients. The MMP-1:TIMP-1 ratio was increased (p < 0.05) in tissue and serum samples from the SHF hypertensive group compared with the other two groups of subjects. The MMP-1 expression was increased (p < 0.01) in the interstitium and cardiomyocytes of SHF hypertensive patients compared with DHF hypertensive and normotensive subjects. The serum MMP-1:TIMP-1 ratio was inversely correlated with ejection fraction (r = -0.510, p < 0.001) and directly correlated with left ventricular end-diastolic diameter (r = 0.549, p < 0.001) in all subjects.CONCLUSIONS These findings show that the pattern of collagen deposits and the balance of the MMP-1/ TIMP-1 system are diffierent in the myocardium of SHF and DHF hypertensive patients. It is proposed that excessive degradation of mysial collagen may be related to the compromise of systolic function in HF hypertensive patients.