Key result
Patients with chronic rheumatic mitral regurgitation had rare myocardial fibrosis but significantly increased collagen degradation, indicated by a higher log MMP-1-to-TIMP-1 ratio compared to controls (-1.2 vs -2.1, p=0.002).
Why the study?
Does chronic rheumatic mitral regurgitation cause myocardial fibrosis and altered collagen turnover compared to healthy controls?
Cross-Sectional (n=36)
No
Does chronic rheumatic mitral regurgitation cause myocardial fibrosis and altered collagen turnover compared to healthy controls?
Absolute Event Rate: -1.2% vs -2.1%
p-value: p=0.002
In chronic rheumatic mitral regurgitation, myocardial fibrosis is uncommon and the disease is characterized by a predominance of collagen degradation rather than increased synthesis.
Myocardial fibrosis is rare in chronic rheumatic mitral regurgitation; this cross-sectional observation leaves open the role of collagen degradation in progression.
BACKGROUND: In chronic rheumatic mitral regurgitation (CRMR), involvement of the myocardium in the rheumatic process has been controversial. Therefore, we sought to study the presence of fibrosis using late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) and biomarkers of collagen turnover in CRMR. METHODS: Twenty-two patients with CRMR underwent CMR and echocardiography. Serum concentrations of matrix metalloproteinase- 1 (MMP-1), tissue inhibitor of MMP-1 (TIMP- 1), MMP-1-to-TIMP-1 ratio, procollagen III N-terminal pro-peptide (PIIINP) and procollagen type IC peptide (PIP) were measured. RESULTS: Four patients had fibrosis on LGE-CMR. PICP and PIIINP concentrations were similar to those of the controls, however MMP-1 concentration was increased compared to that of the controls (log MMP-1 3.5 ± 0.7 vs 2.7 ± 0.9, p = 0.02). There was increased MMP-1 activity as the MMP-1-to- TIMP-1 ratio was higher in CRMR patients compared to the controls ( -1.2 ± 0.6 vs -2.1 ± 0.89, p = 0.002). CONCLUSIONS: Myocardial fibrosis was rare in CRMR patients. CRMR is likely a disease characterised by the predominance of collagen degradation rather than increased synthesis and myocardial fibrosis.
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Meel et al. (2018) conducted a cross-sectional in Chronic rheumatic mitral regurgitation (n=36). Late gadolinium enhancement cardiac magnetic resonance imaging and biomarkers of collagen turnover vs. Age- and gender-matched healthy controls was evaluated on Log MMP-1-to-TIMP-1 ratio (p=0.002). Patients with chronic rheumatic mitral regurgitation had rare myocardial fibrosis but significantly increased collagen degradation, indicated by a higher log MMP-1-to-TIMP-1 ratio compared to controls (-1.2 vs -2.1, p=0.002).
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