Clinical Determinants of Plasma Metaloproteinase-9 in Systolic Chronic Heart Failure

Katerina D. Vitlianova, MD, PhD*

Medical University of Sofia, Sofia, Bulgaria

*Corresponding author: Katerina D. Vitlianova, MD, PhD, Senior assistant professor, Dept. of Internal Medicine «dr.St. Kirkovich», Clinic of Cardiology, Medical University of Sofia, University Hospital «Alexandrovska», 1 St Georgi Sofiiski str., 1431 Sofia, Bulgaria. E-mail: k.


Matrix metalloproteinases (MMPs), particularly MMP-9, are estimated to play an important role in the progression of systolic chronic heart failure (CHF); however, the existing data is incomplete and controversial.

Purpose: The aim of this study was to investigate the changes in plasma MMP-9, associated with CHF and to determine the prognostic value of certain clinical parameters on MMP-9 levels.

Methods: Plasma MMP-9 was measured in 20 normal elderly controls (NEC) and in 59 patients with CHF. Systolic dysfunction was defined as left ventricular ejection fraction (LVEF) ≤40%. Plasma MMP-9 levels and brain natriuretic peptide (BNP) were measured performing immunoassays. Normally distributed variables were reported with mean and skewed variables with the median. Group comparisons were made with the independent t-test, Mann-Whitney U-test and χ2-test, where appropriate. Univariate associations of the variables with MMP-9 were investigated using linear regression analyses. Natural logarithmic transformation was used for skewed variables, including MMP-9 and BNP. Multiple linear regression was used to investigate the independent relations to MMP-9. Statistical analyses were conducted on the SPSS version 13.0 (SPSS Inc, Chicago, IL).

Results: Plasma MMP-9 concentrations (ng/ml) were significantly higher in HF patients (median 1.7, range 0.5-7.3), compared with NEC (median 1.2, range 0.6-2.9) (p=0.01). Circulating BNP and functional class were not significantly correlated with plasma MMP-9. In addition, no significant relationships were observed between MMP-9 and etiology, leucocytes, and creatinkinase (CK). Plasma levels of MMP-9 showed significant correlation with the clinical parameters LVEF, systolic blood pressure (SBP) and atrial fibrillation (AF). Independent predictive effect on MMP-9 levels in multiple regression analysis (F=7.7, p<0.01) were explored for AF, LVEF, SBP and COPD.

Conclusions: Plasma MMP-9 was observed to increase in subjects with CHF. Expectedly, MMP-9 was independently correlated with the degree of cardiac dysfunction and clinical parameters depending on it, including SBP and AF, and with the presence of COPD. Further studies are warranted on the concrete mechanisms of MMP-9 variations in patients with CHF.

metaloproteinase-9, chronic heart failure, atrial fibrillation, systolic blood pressure.

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Int J Biomed. 2011; 1(3):143-149. © 2011 International Medical Research and Development Corporation. All rights reserved.