Turk Kardiyol Dern Ars. 2018; 46(2): 84-91 | 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 Faculty of Medicine, Ankara, Turkey3
Department of Biochemistry, Hacettepe University Faculty of Medicine, Ankara, Turkey
OBJECTIVE Cardiac resynchronization therapy (CRT) induces structural and electrical reverse remodeling of the failing heart. However, the association between native QRS narrowing and cardiac fibrosis markers has not been investigated in patients with an implanted CRT device.
METHODS A total of 41 symptomatic patients diagnosed with systolic heart failure who underwent CRT implantation were included in this study. Electrocardiogram findings and cardiac fibrosis marker levels [galectin-3, growth-differentiation factor-15 (GDF-15) and procollagen III N-terminal propeptide (P3TD)] were collected before and 12 months after initiation of biventricular pacing. Reverse electrical remodeling was defined as a decrease in 12-month intrinsic QRS (iQRS) duration by ≥20 milliseconds after CRT implantation.
RESULTS The median QRS duration decreased from 155 milliseconds (interquartile range [IQR]: 142178 milliseconds) before CRT to 142 milliseconds (IQR: 130161 milliseconds) (p=0.001) after 12 months of CRT. According to the predefined criteria, electrical remodeling was detected in 16 (39.0%) patients. The median galectin-3, GDF-15, and P3TD levels were significantly decreased after CRT implantation in patients with electrical remodeling [27.65 ng/mL (IQR: 24.435.2 ng/mL) vs 23.00 ng/mL (IQR: 16.0-36.7 ng/mL), p=0.017; 3104 pg/mL (IQR: 29234825 pg/mL) vs 2276 pg/mL (IQR: 12943209 pg/mL), p=0.002; 0.43 ng/mL (IQR: 0.230.64) vs 0.15 ng/mL (IQR: 0.040.29 ng/mL), p=0.034, respectively]. The galectin-3, GDF-15, and P3TD levels were not significantly changed in patients without electrical remodeling [26.80 ng/mL (IQR: 23.931.5 ng/mL) vs 28.80 ng/mL (IQR: 23.034.8 ng/mL), p=0.211; 4221 pg/mL (IQR: 27094995 pg/mL) vs 3035 pg/mL (IQR: 20384872 pg/mL), p=0.143; and 0.34 ng/mL (IQR: 0.110.68 ng/mL) vs 0.21 ng/mL (IQR: 0.090.37 ng/mL), p=0.112, respectively].
CONCLUSION The results from the small sample used in this study indicated that electrical reverse remodeling after CRT was associated with a decrease in cardiac fibrosis.
Cardiac resynchronization therapy, electrical remodeling; fibrosis.
How to cite this article
Hamza Sunman, Uğur Canpolat, Hikmet Yorgun, Adem Özkan, Muhammet Ulvi Yalçın, Tülin Bayrak, Levent Şahiner, Ergün Barış Kaya, Asuman Özkara, Kudret Aytemir, Ali Oto. Association between reverse electrical remodeling and cardiac fibrosis markers in patients with cardiac resynchronization therapy. Turk Kardiyol Dern Ars. 2018; 46(2): 84-91
Corresponding Author: Hamza Sunman, Türkiye