| Background and Objective: Chronic congestive heart failure (CHF) is the severe stage of all kinds of heart diseases. The morbidity of heart failure is very high and the 5 years survival rate is similar to malignant tumor. It threatens the healthy of people and the quality of life greatly. With the development of molecular cytology, the practice of large-scale international clinical experiments, and the establishment of neuroendocrine pattern of cardiac dysfunction, the nature of heart failure has been recognized more profoundly. Now it can be confirmed that the basic mechanism of the onset and progress of heart failure is ventricular remodeling. The structure foundation of ventricular remodeling is the alteration of myocardial cells and extracellular matrix, and the chief change of extracellular matrix is the deposition of collagen and fibrosis. Due to the invasive character, the application of myocardial biopsy is limited and the previous researches on myocardial fibrosis are mainly based on animal models and necropsy. Recently some scholars have found that the serum concentration of procollagen terminal propeptide can be used to evaluate the level of myocardialinterstitial fibrosis. When the collagen is synthesized and secreted into blood, the carboxyterminal propeptide of type I procollagen (PIP) and the aminoterminal propeptide of type III procollagen (PIIIP) are cut down by the procollagen terminal propeptide enzyme. So they are thought to be the indirect markers of the inner synthesis of type I and type HI collagen and can be used as a non-invasive way to quantitate the fibrosis of tissues and organs. The objective of this research is to investigate whether the changes of concentration of serum PIP and PIIIP can reflect the changes of extracellular matrix and myocardial fibrosis in CHF patients. Furthermore, to investigate the correlation between these markers and the ultrasound parameters those reflect the systolic and diastolic functions of the heart.Methods: 61 CHF patients were enrolled. The criteria of enrollment were: 1. The enlargement of left ventricle, the enlargement of the end systolic volume of left ventricle and the left ventricular ejection fraction (LVEF) less than 50%. 2. With the history of underlying heart disease, symptoms and physical signs. 3. With or without dyspnea, fatigue or fluid retention etc. All patients were examined to exclude inflammation, cancer, hepatic dysfunction, renal failure, hyperthyroidism or hypothyroidism, bone and joints diseases, diabetes and other metabolism diseases. They were treated irregularly with or without angiotensin converting enzyme inhibitor (ACEI) or spironolactone before hospitalization. All these patients were divided into 3 groups according to the NYHA cardiac functional classification and the LVEF. There were 21 patients in the I class group, 22 in the II class group and 1 8 in the III and IV class group. Also these patients were divided into different groups based on the underlying diseases causing cardiac dysfunction. They were the coronary heart disease group, 25 patients; the hypertension group, 20 patients; the dilated cardiomyopathy group, 10 patients and the congenital heart disease group, 6 patients. At the same time 20 healthy physical examination people were enrolled to be the control group. All patients received the general examination including the hepatic and renal function before accepted. The serum concentration of PIP and PIIIP and the plasma concentration of angiotensinII (AngII) and aldosterone (ALD) were measured by specific radioimmunoassays. Two-dimensional M-mode and Doppler ultrasound recording were obtained todetermine the left ventricular ejection fraction and the ratio between maximal early transmitral flow velocity in diastole and maximal late transmitral flow velocity in diastole (VE/VA). Results:1. Compared with the control group, the hepatic and renal functions were not abnormal in the heart failure groups. After excluding the influence of the hepatic and r... |
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