Background: Congestion in heart failure (HF) induces multiple organ injury, which may cause remodeling of extracellular matrix. We hypothesized that liver fibrogenesis marker, 7S domain of collagen type IV (P4NP 7S) was correlated with congestion and liver injury in HF.
Methods and results: We measured serum P4NP 7S in two cohorts. Cohort 1 included 70 patients undergoing catheterization. P4NP 7S was correlated with pulmonary capillary wedge pressure, right ventricular and atrial pressure (r=0.50, P<0.001, r=0.42, P<0.001, r=0.39, P=0.001, respectively) but not with cardiac index (r=-0.05. P=0.7). Cohort 2 included 145 patients with acute HF, in whom we serially measured P4NP 7S at admission, discharge, early (1-month) and late (6-month) post-discharge period. γ-Glutamyltransferase and B-type natriuretic peptide were independently correlated with P4NP 7S at discharge. The cumulative 1-year incidence of death or HF hospitalization was much higher in the 3rd tertile of P4NP 7S than in the 1st and 2nd tertiles (50%, 25%, and 24%, Log-rank P=0.004). P4NP 7S enhanced risk classification when added to conventional risk factors (net reclassification improvement=0.47, P=0.02). In patients without early readmission, P4NP 7S decreased during hospitalization and remained low for up to 6months, whereas in patients with early readmission, P4NP 7S was persistently elevated during hospitalization, further increased at second admission, and remained high at 6months.
Conclusion: P4NP 7S was correlated with hemodynamics. The results shed new light on the pathophysiology of HF.
Keywords: Collagen type IV; Congestion; Heart failure.
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