Correlation between serum matrix metalloproteinase and myocardial fibrosis in heart failure patients with reduced ejection fraction: A retrospective analysis.

OBJECTIVE: A strong correlation exists between myocardial fibrosis and heart failure (HF). Myocardial fibrosis can be detected by cardiac magnetic resonance (CMR), which is a crucial noninvasive imaging method with high specificity and sensitivity. Matrix metalloproteinases (MMPs) are primary proteases responsible for the degradation of extracellular matrix (ECM) components, and they play a vital role in maintaining the balance between anabolism and catabolism of ECM. This study aims to investigate the correlation between cardiac fibrosis detected on CMR and serum MMP-9 levels in patients with HF. METHODS: We enrolled 53 patients (age: ≥18 years) with left ventricular ejection fraction (LVEF) ≤40%, who received CMR because of various indications. All patients were divided into two groups-with cardiac fibrosis (n=32) and without cardiac fibrosis (n=21)-detected by CMR with late-Gadolinium. Both groups were then compared according to MMP-9 levels. RESULTS: MMP-9 levels were significantly higher in patients with cardiac fibrosis than those without fibrosis (p<0.01). A correlation was determined between the diffusiveness of fibrosis and serum MMP-9 levels. Besides, a statistically significant correlation was determined between MMP-9 measurements and the number of segments with fibrosis (p<0.05). In the group with cardiac fibrosis, LVEF measurements by CMR were significantly lower (p<0.01), with left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) measurements significantly higher (p<0.01), than the other group. Furthermore, we found a statistically significant correlation between MMP-9 levels and LVEDV and LVESV. CONCLUSION: MMP-9 levels correlate with cardiac remodeling in patients with HF and could be useful in predicting left ventricular fibrosis. In clinical practice, the use of serum MMP-9 could provide early consideration of therapies for structural and functional pathology of the heart in patients with HF.

Is the clinical presentation different between men and women admitting to the sleep laboratory?

OBJECTIVES: Sleep and sleep disorders are different in several important ways between men and women. We aimed to investigate gender differences in initial symptoms and associating medical diseases of patients admitting to our sleep clinic. METHODS: Ninety-one patients, 20 women (22%) and 71 men (78%), admitting consecutively to the sleep clinic were studied. A detailed sleep and medical history of the patients was recorded. All patients were questioned for Epworth Sleepiness Scale (ESS) and underwent an entire night of diagnostic polysomnography. Apnea-hypopnea index (AHI) was identified as the total number of apnea and hypopnea per hour of sleep. Hypopnea was defined as a decrease of airflow by at least 50% and desaturations were defined as >or=4% decrease in oxygen saturation. RESULTS: The mean values for age, body mass index, blood pressures and ESS score did not significantly differ between men and women, but AHI (events/h) was significantly higher in men (29.1 +/- 22.7) than women (17.9 +/- 17.7, p < 0.05). Snoring was the most common symptom in both men (95%) and women (90%). Among the main presenting complaints, only morning headache (12 of women 60%, 31 of men 43%, p = 0.04) and dry mouth on awakening (ten of women 50%, 57 of men 80%, p = 0.02) showed a significant difference between the two genders, while among the medical diseases only hypothyroidism (four of women 20% and three of men 4%, p = 0.03) and depression (nine of women 45% and 16 of men 22%, p = 0.02) were seen as statistically higher in women than in men. CONCLUSIONS: Primary care physicians should be aware of obstructive sleep apnea (OSA) in women and the importance of referring women for sleep studies when they complain of symptoms associated with OSA, even if other non-specific symptoms such as morning headaches are reported. Also, hypothyroidism and depression are accompanied with sleep disorders especially in women.