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Tenascin-C as Predictor of Left Ventricular Remodeling and Mortality in Patients With Dilated Cardiomyopathy
  1. Bahadir Sarli, MD*,
  2. Ramazan Topsakal, MD*,
  3. Esma G. Kaya, MD,
  4. Mahmut Akpek, MD*,
  5. Yat Yin Lam, MD,
  6. Mehmet G. Kaya, MD*
  1. From the Departments of *Cardiology and †Microbiology, Erciyes University School of Medicine, Kayseri, Turkey; and ‡Division of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
  1. Received November 26, 2012, and in revised form December 28, 2012.
  2. Accepted for publication January 8, 2013.
  3. Reprints: Bahadir Sarli, MD, Department of Cardiology, Kayseri Education and Research Hospital, 38010, Kayseri, Turkey. E-mail: drsarli{at}yahoo.com.
  4. The authors have no conflicts of interest.

Abstract

Background Several cardiac biomarkers, especially brain natriuretic peptide (BNP) and N-terminal (NT)-proBNP, have been used as predictors of prognosis and negative remodeling in DCM. In the present study, we aimed to evaluate the prognostic value of tenascin-C in dilated cardiomyopathy (DCM) and whether it can be used to determine reverse remodeling in patients with DCM.

Methods Sixty-six patients with DCM were followed up for 12 months after initiation of medical treatment including carvedilol, ramipril (candesartan if ramipril was not tolerated), spironolactone, and furosemide. Tenascin-C and NT-proBNP measurements and transthoracic echocardiography were performed at baseline and at 12 months.

Results At 12 months, a significant improvement in New York Heart Association class (2.57 ± 0.6 vs. 1.87 ± 0.5; P < 0.0001), left ventricular end-diastolic volume (217 ± 47 vs 203 ± 48; P < 0.0001), left ventricular ejection fraction (29.1 ± 5.5 vs 30.9 ± 3.8; P < 0.0001), NT-proBNP (2019 ± 558 vs 1462 ± 805; P < 0.0001), and tenascin-C (76 ± 19 vs 48 ± 28; P < 0.0001) values were observed, compared with baseline. Importantly, decrease in tenascin-C values were correlated with increase in left ventricular ejection fraction. Tenascin-C (odds ratio [OR], 1.896; <95% confidence interval [CI], 1.543–2.670; P = 0.02), diabetes mellitus (OR, 2.456; G95% CI, 1.987–3.234; P = 0.01) and hypertension (OR: 2.106, <95% CI, 1.876–2.897; P = 0.03) were independent predictors of mortality in patients with DCM.

Conclusion Reverse ventricular remodeling obtained with carvedilol, ramipril/candesartan, and spironolacton is associated with decreases in left ventricular end-diastolic volume, left ventricular end-systolic volume, tenascin-C levels, and NT-proBNP levels. Consequently, tenascin-C may be used to evaluate reverse remodeling in patients with DCM.

Key Words
  • Tenascin-C
  • reverse remodeling
  • dilated cardiomyopathy

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