Prognostic potential of cardiac structural and functional parameters and N-terminal propeptide of type III procollagen in predicting cardiac fibrosis one year after myocardial infarction with preserved left ventricular ejection fraction

Abstract

The aim of the study were to evaluate the prognostic potential of serum level of N-terminal propeptide procollagen type III (PIIINP) and heart parameters for predicting heart cardiac fibrosis 1 year after ST-segment elevation myocardial infarction (STEMI) with preserved left ventricular ejection fraction (LVEF). 68 patients with STEMI and preserved LVEF with acute heart failure of the I-III degree according to the Killip classification were examined. Echocardiography was performed and PIIINP levels were measured on days 1 and 12, as well as 1 year after STEMI. A year after STEMI, was performed contrast magnetic resonance imaging and patients were assigned into four groups depending on the severity of cardiac fibrosis: cardiac fibrosis 0% (n=49, 57% of 86 patients); ≤5% (n=18, 20.9%); 6-15% (n=10, 11.6%); ≥16% (n=9, 10.5%). Direct correlations between the severity of cardiac fibrosis, PIIINP level and indicators of diastolic function were established. The risk of cardiac fibrosis increases at the level of PIIINP ≥381.4 ng / ml on the 12th day after STEMI with preserved LVEF (p=0.048). Thus, measuring the level of PIIINP in the inpatient period can allow timely identification of patients with a high risk of cardiac fibrosis 1 year after STEMI with preserved LVEF.

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“…PIIINP is cleaved from type III procollagen during type III collagen synthesis and degradation, thus reflecting type III collagen turnover 43 . Elevated PIIINP is associated with myocardial fibrosis, 44,45 diastolic dysfunction, 46 and overall poor outcomes in heart failure and other cardiovascular diseases 47,48 …”

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“…A large number of related studies are needed for further exploration in the future. MRA have shown to affect circulating levels of biomarkers indicating cardiac fibrosis and function such as MMP, PIIINP, and NT-pro BNP [19,25,[36][37][38][39][40]. Therefore, 9 Cardiovascular Therapeutics we call for further investigation on noninvasive indicators in response to MRA to prove its predictive value in cardiac remodeling.…”

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“…However, the correlation of P1CP with cardiac fibrosis extent has to be demonstrated, and it must be noted that P1CP circulating levels may be modulated by other non-fibrotic or non-cardiac processes. Assessing peptides associated with collagen synthesis alone does not seem to constitute a sufficient strategy to specifically detect cardiac fibrosis [ 112 , 113 ]. In a multiparametric approach combining PICP, PIIINP, cardiac fibrosis area determination, and imaging on dilated cardiomyopathy biopsies, a study reported that P1CP/LGE combination provided a sensitive tool to predict adverse cardiac outcomes and that patients positive for cardiac fibrosis presented higher levels of P1CP and LGE [ 112 , 113 , 114 ].…”