Biochemical markers of collagen metabolism in patients with acute myocardial infarction. Another prognostic marker?
Abstract
There is little doubt that current cardiology has increasingly used biochemical markers in assessing the prognosis of patients after myocardial infarction (MI). Methods reflecting myocyte damage (troponins I and T, CK-M) have been established in clinical practice.
In recent years, several studies have documented the prognostic value of inflammatory markers (CRP, interleukin 6, TNF). In this context, little is known about the role played by the extracellular matrix (ECM) and, particularly, about collagen metabolism and its alterations in MI healing and, also, about the prognostic value of these metabolic changes.
The authors present a summary of current concepts on changes in post-IM myocardial collagen metabolism based on clinical trials addressing this issue. The trial used the method of determining the serum levels of collagen metabolism markers (PICP, ICTP, PIIINP) to assess their prognostic value.
A correlation has been repeatedly demonstrated between the serum levels of PICP, PIIINP, as determined in the subacute MI period, extent of left ventricular remodeling or its altered function, and the incidence of post-MI clinical events such as heart failure and cardiac death. Collagen I and III degradation and synthesis have been shown to start very early after MI.
The process of synthesis continues as many as several months post-MI, with collagen III synthesis initially prevailing to be later dominated by collagen I synthesis. At 30 days post-MI, patients undergoing successful revascularization showed significantly lower collagen I and III synthesis rates.
In conclusion, collagen metabolism markers are not only able to reflect changes in ECM in the process of MI healing but, also, to assess the development of left ventricular function after MI and some clinical cardiac complications of MI even in the long term.