1. Role of Myocardial Collagen in Severe Aortic Stenosis With Preserved Ejection Fraction and Symptoms of Heart Failure
- Author
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Tomás Echeverría, Iñaki Villanueva, Iñaki Sanz, Elena Zubillaga, Asier Garro, Susana Ravassa, Ramón Querejeta, Itziar Solla, M.R. Elizalde, Alberto Elosegui-Artola, Arantxa González, Jesús González, Ion Andreu, Ane Lazkano, Kattalin Echegaray, Pere Roca-Cusachs, Alberto Sáenz, Begoña López, and Javier Díez
- Subjects
Male ,0301 basic medicine ,medicine.medical_specialty ,Diastole ,030204 cardiovascular system & hematology ,Microscopy, Atomic Force ,Severity of Illness Index ,Collagen Type I ,Extracellular matrix ,03 medical and health sciences ,0302 clinical medicine ,Elastic Modulus ,Internal medicine ,Natriuretic Peptide, Brain ,Collagen network ,medicine ,Humans ,Aged ,Aged, 80 and over ,Heart Failure ,Microscopy, Confocal ,Ejection fraction ,Decellularization ,business.industry ,Myocardium ,Stroke Volume ,Aortic Valve Stenosis ,General Medicine ,Middle Aged ,medicine.disease ,Immunohistochemistry ,Peptide Fragments ,Biomechanical Phenomena ,Extracellular Matrix ,Stenosis ,Collagen Type III ,030104 developmental biology ,Heart failure ,Cardiology ,Female ,Myocardial fibrosis ,business ,Blood Flow Velocity - Abstract
We investigated the anatomical localization, biomechanical properties, and molecular phenotype of myocardial collagen tissue in 40 patients with severe aortic stenosis with preserved ejection fraction and symptoms of heart failure.Two transmural biopsies were taken from the left ventricular free wall. Mysial and nonmysial regions of the collagen network were analyzed. Myocardial collagen volume fraction (CVF) was measured by picrosirius red staining. Young's elastic modulus (YEM) was measured by atomic force microscopy in decellularized slices to assess stiffness. Collagen types I and III were measured as CCompared with controls, patients exhibited increased mysial and nonmysial CVF and nonmysial:mysial CVF ratio (P.05). In patients, nonmysial CVF (r = 0.330; P = .046) and the nonmysial:mysial CVF ratio (r = 0.419; P = .012) were directly correlated with the ratio of maximal early transmitral flow velocity in diastole to early mitral annulus velocity in diastole. Both the CThese findings suggest that, in patients with severe aortic stenosis with preserved ejection fraction and symptoms of heart failure, diastolic dysfunction is associated with increased nonmysial deposition of collagen, predominantly type I, resulting in increased extracellular matrix stiffness. Therefore, the characteristics of collagen tissue may contribute to diastolic dysfunction in these patients.
- Published
- 2017
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