Plasma metalloproteinase-9 and restrictive filling pattern as major predictors of outcome in patients with ischemic cardiomyopathy

Abstract Objective Assessment of plasma matrix metalloproteinase-9 (MMP-9) and Doppler markers of increased left ventricular (LV) filling pressure may be added to risk stratify patients with ischemic cardiomyopathy (IC). Therefore, we aimed at investigating the value of plasma MMP-9 and restrictive filling pattern (RFP) in IC patients. Methods Eighty-eight consecutive patients hospitalized for heart failure (LV ejection fraction ≤ 40%) due to IC were enrolled. A complete M-mode and two-dimensional echo-Doppler examination were performed. Patients were defined as having RFP if they had a mitral E wave deceleration time  Results Median value of MMP-9 was 714 ng/ml. On univariate analysis, a number of measurements predicted the composite end point: NYHA class > 2, RFP, MMP-9 > 60.5 ng/ml, LV ejection fraction   1742 pg/ml, and glomerular filtration rate  2 . Independent variables of outcome were anemia (HR = 1.9, p = 0.031), and the combination of plasma MMP-9 and RFP (HR = 3.2, p = 0.004). On Kaplan–Meier survival curves, patients with elevated MMP-9 levels and RFP had the lowest event-free survival rate (log-rank: 29.0, p  Conclusion MMP-9 levels and RFP have an incremental predictive value to risk classify IC patients.