Biochemical assessment of myocardial fibrosis in hypertensive heart disease

Fibrous tissue accumulation is an integral feature of the adverse structura l remodeling of cardiac tissue seen with hypertensive heart disease. Given the importance of fibrous tissue in leading to myocardial dysfunction and f ailure, noninvasive monitoring of myocardial fibrosis by use of serological markers of collagen turnover could prove a clinically useful tool, particu larly given the potential for cardioprotective and cardioreparative pharmac ological strategies. An emerging experimental and clinical experience holds promise for the use of radioimmunoassays of various serological markers of fibrillar collagen type I and type III turnover in arterial hypertension. More specifically, the measurement of serum concentrations of procollagen t ype I C-terminal propeptide (a peptide that is cleaved from procollagen typ e I during the synthesis of fibril-forming collagen type I) may provide ind irect diagnostic information on both the extent of myocardial fibrosis and the ability of antihypertensive treatment to diminish collagen type I synth esis and reduce myocardial fibrosis. This approach represents an exciting a nd innovative strategy, and available data set the stage for larger trials, in which noninvasive measures of fibrosis in hypertensive heart disease co uld prove useful.