Key result
Baseline TIMP-1 levels independently predicted long-term mortality in heart failure patients treated with cardiac resynchronization therapy (HR 1.18; 95% CI 1.05-1.33; P=0.007).
Why the study?
Do baseline TIMP-1 and MMP-2 levels predict long-term mortality in heart failure patients treated with cardiac resynchronization therapy?
Cohort (n=42)
Do baseline TIMP-1 and MMP-2 levels predict long-term mortality in heart failure patients treated with cardiac resynchronization therapy?
Hazard Ratio: 1.18 (95% CI 1.05–1.33)
p-value: p=0.007
Baseline TIMP-1 levels are a strong independent predictor of long-term mortality in heart failure patients undergoing cardiac resynchronization therapy.
TIMP-1 may refine mortality risk stratification in CRT recipients; hypothesis-generating and requires prospective validation before clinical use.
AIMS: Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are involved in cardiac remodelling. Available information regarding their prognostic utility in heart failure (HF) and cardiac resynchronization therapy (CRT) is controversial. The aim of this study was to analyse MMP-2 and TIMP-1 levels as predictors of long-term mortality in HF patients treated with CRT. METHODS AND RESULTS: We prospectively included 42 consecutive patients with successfully implanted CRT. Matrix metalloproteinase-2 and TIMP-1 assays were performed prior to implant. Patients were evaluated at baseline and at the outpatient clinic at 6-month intervals. Clinical response, left ventricular (LV) remodelling, and mortality were analysed. During a mean follow-up of 60 ± 34 months, long-term mortality from any cause was 36% (15 patients). The cause of death was end stage of HF in 12 patients, sudden death in 2 patients, and 1 unknown. After adjustment using a Cox regression model, the independent predictors of long-term mortality were baseline TIMP-1, hazard ratio (HR) 1.18 (95% confidence interval (95% CI) [1.05-1.33], P = 0.007), baseline glomerular filtration rate (GFR), HR 0.97 (95% CI [0.94-1.00], P = 0.05), and permanent atrial fibrillation (AF), HR 3.14 (95% CI [1.02-9.67], P = 0.04). Area under receiver operating characteristic curve for TIMP-1 was 0.79 (95% CI [0.63-0.94]). Tissue inhibitor of matrix metalloproteinase-1 ≥ 248 ng/mL predicts mortality with 80% sensitivity and 71% specificity. CONCLUSION: Tissue inhibitor of matrix metalloproteinase-1 is a powerful predictor of long-term mortality in HF patients treated with CRT.
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Trucco et al. (2015) conducted a cohort in Heart failure treated with cardiac resynchronization therapy (n=42). Baseline TIMP-1 levels was evaluated on Long-term mortality (HR 1.18, 95% CI 1.05-1.33, p=0.007). Baseline TIMP-1 levels independently predicted long-term mortality in heart failure patients treated with cardiac resynchronization therapy (HR 1.18; 95% CI 1.05-1.33; P=0.007).
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