Reverse ventricular remodelling after cardiac resynchronization therapy is associated with a reduction in serum tenascin-C and plasma matrix metalloproteinase-9 levels

Background: In heart failure patients, cardiac resynchronization therapy (CRT) leads to reverse ventricular remodelling. Aim: The aim of this study was to evaluate whether changes in levels of circulating biomarkers of extracellular matrix metabolism correlate with the response to CRT. Methods and results: Clinical parameters, left ventricular (LV) volumes, and circulating levels of tenascin-C (TNC), matrix metalloprotemase-2 (MMP-2), MMP-9, and amino-terminal propeptide of brain natriuretic peptide (NT-proBNP) were assessed in 64 patients at baseline and 6 months follow-up. The majority of patients (72%) showed a > 10% reduction in LV end-systolic volume at follow-up, and were classified as responders to CRT. The remaining patients were classified as non-responders. In responders, a significant decrease in circulating levels of TNC (from 60 +/- 40 ng/mL to 47 +/- 30 ng/mL, p < 0.0 1), MMP-9 (from 55 +/- 30 AU to 44 +/- 27 AU, p < 0.0 1), and NT-proBNP (from 2106 +/- 1805 pg/mL to 1132 +/- 1289 pg/mL, p < 0.001) were observed at follow-up; MMP-2 levels were unchanged. In non-responders TNC, NT-proBNP, MMP-9 and MMP-2 levels remained unchanged. Conclusion: At 6 months follow-up, CRT was associated with reverse LV remodelling, and a significant decrease in TNC, MMP-9, and NT-proBNP levels. This suggests an important role of ECM modulation in the process of reverse ventricular remodelling in patients responding to CRT. +/- 2007 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.