Resumen:
BACKGROUND Myocardial fibrosis may increase vulnerability to poor prognosis in patients with heart failure (HF), even in those patients exhibiting left ventricular reverse remodeling (LVRR) after guideline-based therapies.OBJECTIVES This study sought to characterize fibrosis at baseline in patients with HF with left ventricular ejection fraction (LVEF) <50% by determining serum collagen type I-derived peptides (procollagen type I C-terminal propeptide [PICP] and ratio of collagen type I C-terminal telopeptide to matrix metalloproteinase-1) and to evaluate their association with LVRR and prognosis.METHODS Peptides were determined in 1,034 patients with HF at baseline. One-year echocardiography was available in 665 patients. Associations of peptides with 1-year changes in echocardiographic variables were analyzed by multivariable linear mixed models. LVEF was considered improved if it increased by & GE;15% or to & GE;50% or if it increased by & GE;10% to >40% in patients with LVEF & LE;40%. Cardiovascular death and HF-related outcomes were analyzed in all patients ran-domized to derivation (n = 648) and validation (n = 386) cohorts.RESULTS Continuous associations with echocardiographic changes were observed only for PICP. Compared with high-PICP (& GE;108.1 ng/mL) patients, low-PICP (<108.1 ng/mL) patients exhibited enhanced LVRR and a lower risk of HF-related outcomes (P & LE; 0.018), with women and nonischemic patients with HF showing a stronger LVEF increase (interaction P & LE; 0.010). LVEF increase was associated with a better prognosis, particularly in low-PICP patients (interaction P & LE; 0.029). Only patients with both low PICP and improved LVEF exhibited a better clinical evolution than patients with nonimproved LVEF (P < 0.001).CONCLUSIONS Phenotyping with PICP, a peptide associated with myocardial fibrosis, may be useful to differentiate patients with HF who are more likely to experience clinical myocardial recovery from those with partial myocardial improvement. (J Am Coll Cardiol HF 2023;11:58-72) & COPY; 2023 by the American College of Cardiology Foundation.
