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. 2019 Apr 15;9(1):6103.
doi: 10.1038/s41598-019-42468-4.

Low fibrosis biomarker levels predict cardiac resynchronization therapy response

Grégoire Massoullié  1   2 , Vincent Sapin  3 , Sylvain Ploux  4 , Patrick Rossignol  5   6 , Aurélien Mulliez  7 , Frédéric Jean  1 , Pierre-Yves Marie  8 , Charles Merlin  9 , Bruno Pereira  7 , Marius Andronache  1 , Pascal Motreff  1   2 , Xavier Chabin  1 , Jean-Marc Sellal  10 , Bernard Citron  1   2 , Jean-René Lusson  1   2 , Charles Vorilhon  1 , Guillaume Clerfond  1   2 , Pierre Bordachar  4 , Faiez Zannad  5   6 , Romain Eschalier  11   12   13
Affiliations

Low fibrosis biomarker levels predict cardiac resynchronization therapy response

Grégoire Massoullié et al. Sci Rep. .

Abstract

Cardiac fibrosis is associated with heart failure and poor prognosis. Fibrosis biomarkers have been poorly evaluated as a tool to predict cardiac resynchronization therapy (CRT) response generating conflicting results. The present study assessed the predictive value of cardiac fibrosis biomarkers on CRT response. Patients underwent clinical examination, echocardiography and blood fibrosis biomarker evaluation prior to CRT implantation. At six months, a positive response to CRT was defined by a composite endpoint of no death or hospitalization for heart failure, and presence of left ventricular (LV) reverse remodeling (decrease in LV end-systolic volume ≥15%). Sixty patients were included in a multicenter study. At 6 months, 38 were positive responders to CRT and reached the response criteria (63%). Compared to non-responders, CRT responders displayed lower concentration levels of the fibrosis biomarkers procollagen type I C-terminal propeptide [PICP 135[99-166] ng/ml vs. 179[142-226]ng/ml, p = 0.001)] and procollagen type III N-terminal propeptide [PIIINP 5.50[3.66-8.96] ng/ml vs. 8.01[5.01-11.86]ng/ml, p = 0.014)] at baseline. In multivariate analysis, a PICP ≤ 163 ng/ml was associated with a positive CRT response [OR = 7.8(1.3-46.7), p = 0.023] independently of the presence of LBBB, QRS duration, LV lead position or non-ischemic cardiomyopathy. Altogether, the present findings show that a lower degree of cardiac fibrosis is associated with a positive response after CRT implantation. PICP evaluation before CRT implantation could help improve patient selection.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
PICP level according to CRT response and left ventricular remodeling at 6 months. ΔESVi: Indexed End-systolic Volume variation at 6 months; HF: heart failure.
Figure 3
Figure 3
PICP level according to CRT response and baseline characteristics. ΔESVi: Indexed End-systolic Volume variation at 6 months. LBBB = Left bundle branch block; DCM = Non-ischemic cardiomyopathy; LV = Left ventricle.
Figure 4
Figure 4
Response to CRT ROC curve according to PICP level (AUC = 0.75[0.62–0.87]).
See this image and copyright information in PMC

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