The differences in the relationship between diastolic dysfunction, selected biomarkers and collagen turn-over in heart failure patients with preserved and reduced ejection fraction

Abstract

Background: The aim of the study was to assess the correlation of the selected biomarkers and collagen turn-over indices with advanced echocardiographic parameters among patients with preserved and reduced ejection fraction (EF).

Methods: We included 62 patients with the symptomatic heart failure. The patients were divided in to two groups according to the evaluated ejection fraction (EF — Simpson method): heart failure with reduced ejection fraction (HFrEF) group — 30 patients with low EF — 35–50% (16 male, mean age 54.9 ± 12.6), heart failure with preserved ejection fraction (HFpEF) group — 32 patients with EF > 50% (16 male, mean age 62.3 ± 7.6). Clinical evaluation included 6-min walk test, biochemistry, procollagen type I N-terminal propeptide (PINP), procollagen type III N-terminal propetide (PIIINP), matrix metaloproteinase-2 (MMP2), ghrelin, and galectin-3 levels measurements. Echocardiographic examination was performed with analysis of diastolic function and global longitudinal strain (GLS).

Results: The GLS in the HFrEF group was significantly lower than in the HFpEF group at the baseline (GLS: 9.56 vs. 16.03, p < 0.01). There was a strong negative correlation of the PIIINP and GLS in HFrEF group (r = –0.74, p = 0.005), but only a moderate negative correlation in HFpEF (r = –0.55, p = 0.02). In the HFrEF group, there was a moderate negative correlation between the baseline level of galectin-3 and GLS (r = –0.59, p = 0.03). The correlation of ghrelin and tissue inhibitor of matrix metalloproteinase-1 with EF in the HFrEF group was moderate and statistically significant (r = 0.62, p = 0.02 and r = –0.63, p = 0.02, respectively).

Conclusions: Procollagen type III peptide has a strong negative correlation with left ventricular GLS. Galectin-3 relationship with strain may indicate novel pathophysiological pathways and requires further investigation.