The Prognostic Value of Collagen Turnover Biomarkers in Cardiac Resynchronization Therapy- A Subanalysis of TRUST CRT Randomized Trial population.

Substantial proportion of patients do not respond to cardiac resynchronization therapy (CRT). Various echocardiographic and biochemical markers including collagen turnover biomarkers were suggested to predict CRT results. However, its pathological significance remains controversial.The aim of present study was to evaluate the relationship between collagen turnover biomarkers (PINP and PIIINP), NT-proBNP, hsCRP, matrix metalloproteinases (MMP-2, MMP-9) and echocardiographic response and clinical outcomes.Study population consisted of patients enrolled to TRUST-CRT trial. Blood samples were obtained before CRT-D implantation. The levels of PIIINP, PINP MMP-2 and MMP-9 ware determined by commercially available ELISA kits. hsCRP and NT-proBNP were determined in a standard way.Samples were collected from 74 of 100 enrolled patients. The multivariate logistic regression demonstrated that low PIIINP (OR: 3.56; 95% CI 1.23-10.24; P=0.017) and baseline ejection fraction (OR: 2.14; 95%CI 1.11-4.11; P=0.02) were favorably associated with echocardiographic response. PIIINP and NT-proBNP appeared to be independent predictors of all-cause mortality (OR for PIIINP: 3.11; 95% CI 1.21-7.89; P=0.033, OR for NTproBNP: 2.05; 95% CI 1.11-4.96; P=0.039) and MACE (OR for PIIINP: 3.56; 95%CI 1.53-9.15; P=0.007, OR for NTproBNP: 4.51; 95% CI 1.75-11.6; P= 0.001). PIIINP levels showed significant additive value in predicting mortality when comparing to NT-proBNP, but was not superior to ejection fraction in predicting response. Survival analysis with cutoff values identified on the basis of ROC analysis confirmed a significant benefit associated with low baseline PIIINP levels.Low PIIINP levels are associated with favorable echocardiographic response and longtime survival in CRT recipients.ClinicalTrials.gov identifier: NCT00814840.