Turk Kardiyol Dern Ars. Ahead of Print: TKDA-80236 | DOI: 10.5543/tkda.2017.80236
Association between Reverse Electrical Remodeling and Cardiac Fibrosis Markers in Patients with Cardiac Resynchronization Therapy
, Uğur Canpolat2
, Hikmet Yorgun2
, Adem Özkan3
, Muhammet Ulvi Yalçın2
, Tülin Bayrak3
, Levent Şahiner2
, Ergün Barış Kaya2
, Asuman Özkara3
, Kudret Aytemir2
, Ali Oto21
Department Of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey2
Department Of Cardiology, Hacettepe University, Ankara, Turkey3
Department Of biochemistry, Hacettepe University, Ankara, Turkey
OBJECTIVE Cardiac resynchronization therapy (CRT) induces structural and electrical remodelling of the failing heart. However, association between native QRS narrowing and cardiac fibrosis markers has not been investigated in patients with CRT implantation.
METHODS A total of 41 symptomatic patients diagnosed with systolic heart failure, who underwent CRT implantation were included in the study. ECG findings and cardiac fibrosis marker levels (galectin-3, growth-differentiation factor-15 [GDF-15] and procollagen III N-terminal propeptide [prokol-3NT]) were collected before and twelve months after biventricular pacing. Reverse electrical remodelling was defined as a decrease in 12-months intrinsic QRS (iQRS) duration by ≥20 ms after CRT implantation.
RESULTS QRS duration decreased from 155 (142-178) ms before CRT to 142 (130-161) ms (P=0.001) after 12 months of CRT. According to predefined criteria, electrical remodelling was detected in 16 (39.0%) patients. Galectin-3, GDF-15 and prokol-3NT levels were significantly decreased after CRT implantation in patients with electrical remodelling (27.65 [24.4-35.2] vs 23.00 [16.0-36.7] ng/ml; p= 0.017, 3104 [2923-4825] vs 2276 [1294-3209] pg/ml; p=0.002, 0.43 [0.23-0.64] vs 0.15 [0.04-0.29]; p= 0.034, respectively). However, Galectin-3, GDF-15 and prokol-3NT levels were not significantly changed in patients without electrical remodelling (26.80 [23.9-31.5] vs 28.80 [23.0-34.8] ng/ml; p= 0.211, 4221 [2709-4995] vs 3035 [2038-4872] pg/ml; p=0.143 and 0.34 ng/ml [0.11-0.68] vs 0.21 ng/ml [0.09-0.37]; p=0.112, respectively).
CONCLUSION In this small sample sized study, we found that electrical remodelling after CRT is associated with a decrease in cardiac fibrosis.
Cardiac resynchronization therapy, electrical remodeling, fibrosis
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Corresponding Author: Hamza Sunman, Türkiye