Background: Ischemic heart disease (IHD) remains one of the leading causes of chronic heart failure (CHF) worldwide. Progressive myocardial remodeling and fibrosis significantly contribute to deterioration of cardiac function and unfavorable cardiovascular outcomes. Connective tissue growth factor (CTGF) is recognized as an important mediator involved in extracellular matrix remodeling and myocardial fibrosis. Objective: To evaluate the clinical significance of CTGF as a marker of myocardial remodeling and left ventricular dysfunction in patients with ischemic heart disease and chronic heart failure. Materials and Methods: This prospective observational study included 67 patients with ischemic heart disease complicated by chronic heart failure who were hospitalized at the Multidisciplinary Clinic of Tashkent State Medical University. All patients underwent comprehensive clinical examination, laboratory testing, and transthoracic echocardiography. Serum CTGF levels were measured to assess fibrotic activity. Patients were stratified according to CTGF concentration. Statistical analysis was performed using standard parametric and nonparametric methods. A p-value <0.05 was considered statistically significant. Results: Elevated CTGF levels were identified in 49 (73.1%) patients, whereas normal concentrations were observed in 18 (26.9%) patients. Patients with elevated CTGF demonstrated lower left ventricular ejection fraction (38–44%) compared with patients with normal CTGF levels (45–50%). Echocardiographic signs of myocardial remodeling were significantly more frequent in the elevated CTGF group. Increased CTGF concentration was associated with progressive myocardial fibrosis and worsening systolic function. Conclusion: CTGF is associated with adverse myocardial remodeling and impaired left ventricular systolic function in patients with ischemic heart disease and chronic heart failure. Combined assessment of CTGF and echocardiographic parameters may improve risk stratification and facilitate individualized treatment strategies.
Connective Tissue Growth Factor as A Marker of Myocardial Remodeling and Left Ventricular Dysfunction in Patients with Ischemic Heart Disease and Chronic Heart Failure
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References
Braunwald E. The war against heart failure: the Lancet lecture. Lancet. 2015;385(9970):812–824. DOI:10.1016/S0140-6736(14)61889-4
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145:e895-e1032. DOI:10.1161/CIR.0000000000001063
McDonagh TA, Metra M, Adamo M, et al. ESC Guidelines for Heart Failure. Eur Heart J. 2021;42(36):3599-3726. DOI:10.1093/eurheartj/ehab368
Frangogiannis NG. Cardiac fibrosis. Mol Aspects Med. 2019;65:70-99. DOI:10.1016/j.mam.2018.07.001
Travers JG, Kamal FA, Robbins J, et al. Cardiac Fibrosis. Circ Res. 2016;118(6):1021-1040. DOI:10.1161/CIRCRESAHA.115.306565
Lipson KE, Wong C, Teng Y, Spong S. CTGF is a central mediator of tissue remodeling and fibrosis. Fibrogenesis Tissue Repair. 2012;5(Suppl 1):S24. DOI:10.1186/1755-1536-5-S1-S24
Leask A. Potential therapeutic targets for cardiac fibrosis. Ann Med. 2010;42(5):381-390. DOI:10.3109/07853890.2010.492449
Kong P, Christia P, Frangogiannis NG. The pathogenesis of cardiac fibrosis. Cell Mol Life Sci. 2014;71:549-574. DOI:10.1007/s00018-013-1349-6