Heart Failure Clinical Trial
To assess the diagnostic and prognostic usefulness of serum markers of left ventricular remodeling for predicting congestive heart failure.
BACKGROUND:
Recent studies have established that cardiac extracellular matrix (ECM) remodeling is a
major determinant of pathologic left ventricular hypertrophy (LVH) and progressive left
ventricular dilatation, and as a result, contributes to the development of left ventricular
dysfunction and overt congestive heart failure (CHF). The recent development of reliable
serologic assays for procollagen peptides, metalloproteinases (MMP) and their tissue
inhibitors (TIMP), and cytokines permits the in vivo assessment of LV ECM remodeling, and
raises the possibility of expanding the utility of these markers 'from the bench to the
bedside.' Prior studies of ECM biomarkers in congestive heart failure have been limited to
cross-sectional investigations of small samples of highly selected patients with advanced
disease. The fundamental question whether serum markers of ECM remodeling are important
correlates of left ventricular dilatation or left ventricular hypertrophy, or are
independent predictors of incident congestive heart failure in the community remains
unanswered.
DESIGN NARRATIVE:
The aims of the study are to: determine the relationships between serum markers of ECM
remodeling and traditional congestive heart failure risk factors; analyze the
cross-sectional relations between markers of ECM remodeling and echocardiographic left
ventricular hypertrophy and left ventricular dilatation, Doppler indices of left ventricular
filling and serum natriuretic peptides; investigate prospectively the relationships between
ECM remodeling markers and progressive left ventricular dilatation and left ventricular
hypertrophy and congestive heart failure incidence, adjusting for standard risk factors.
Stored samples from the Framingham Offspring and Omni cohorts will be used. Participants at
the extremes of the joint distributions of left ventricular wall thickness and left
ventricular internal dimension from echocardiograms performed at earlier Framingham exams
will be sampled.
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