Background The differences in concentrations of MMP and its natural inhibitor TIMP in patients with EF <45 and EF >45 during hospitalisation with acute heart failure have yet to be defined. The objectives of this study were to compare the prognostic value of biomarkers of remodelling and fibrosis between these populations. Herein we evaluated the potential difference of circulating MMP (2,3,9) and TIMP (1–4) levels in these two groups of patients hospitalised with AHF
Methods A prospective observational study of 400 patients hospitalised with symptomatic acute heart failure was performed. Plasma levels of NT-proBNP, MMP-2, MMP-3, MMP-9, along with inhibitors (TIMP-1 to 4) were measured at admission and at discharge. Patients were divided into two groups (EF <45 and EF >45) based on TTE and the prognostic ability of the remodelling biomarkers was assessed prospectively. The primary end point was composite of all cause mortality and HF related hospitalisation at one year.
Results Mean LVEF was 25.6 ± 96 ± 9.1% in group 1 (282 patients) and 63.3 ± 73 ± 7.3% in group 2 (97 patients). High admission NT-proBNP, MMP-2 and low MMP-9 levels were noted in patients with EF <45 as compared to with EF >45 (P < 0P <0.05), the only significant difference between the groups remaining after adjusting for possible confounding variables was NT-proBNP (P = P = 0.001). Inpatients with EF <45 (group 1), above median MMP-3 (p 0.001) as compared to below median MMP-9 (p 0.01) in EF >45 (group 2) were more likely to experience outcome. In addition we noticed those with EF <45 had low sBP, high EDV, ESV and more likely to be prescribed beta blockers and spironolactone at discharge.
Conclusions Patients with EF <45 or EF >45 presenting with similar symptoms and functional limitations exhibit differential concentration of MMP-2, MMP-3 and MMP-9 during hospitalisation with acute heart failure. Those with EF <45 exhibits significantly high NT-proBNP levels as compared to patients with EF >45. Higher median MMP-3 levels in group 1 and low median MMP-9 levels in group 2 predicts future combined outcome suggesting heterogeneity and differences in the mechanisms related to their release or clearance. No significant differences were noted in TIMP levels between the two groups.
- MMP and TIMP
- Acute Heart Failure
- Differencial Prognostication
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