Can serum tenascin-c be used as a marker of inflammation in patients with dilated cardiomyopathy?

Abstract

Tenascin-C (TN-C), an extracellular matrix glycoprotein, is specifically expressed at high levels during embryonic development, but not in the adult heart. TN-C reappears at sites of inflammatory tissue remodeling or wound healing under various pathologic conditions, such as acute myocardial infarction, acute myocarditis,and some cases of cardiomyopathy. Therefore, the expression of TN-C might be useful for detecting the clinical characteristics of, and ventricular remodeling in, dilated cardiomyopathy (DCM). Objectives: To evaluate the role of TN-C as a sensitive marker for active inflammation in children with newly onset DCM Methods: This case controlled study included 24 patients aged from 6 to 72 months with a mean age 45.19 ± 11.03 compared to 20 age and sex matched healthy children. The subjects were divided into 3 groups. Group 1: included twelve patients with acute onset DCM, (less than 6 months duration) ,Group 2: included twelve patients with established chronic DCM, (more than 6 months duration) and Group 3: twenty (20) healthy age and sex matched children served as control group: all studied patients were subjected to full medical history ,thorough clinical examination. Investigations included: Serum Tenascin-C , chest X-ray and echocardiography using conventional parameters as M-mode, 2D, CW Doppler and 2D speckle tracking technique. Results: The 2D Speckle Tracking data showed that the patients group had lower Global peak Strain Longitudinal Apical long axis( G SL ap lax), G peak SL apical 4 chamber(a4c), G peak SL apical 2 chamber(a2c) and G peak SL average with highly statistical significant difference using T-test. Moreover the global echocariographic assessment showed that acute cases had lower G peak SL ap lax, G peak SL ap4c, G peak SL a2c, G peak SL avg, than the chronic cases with a highly statistically significant difference (P < 0.001). These data confirm furthermore the global affection of the acute DCM cases than the chronic cases.Our study showed highly significant statistical elevation of serum Tenascin-c among DCM patients than in controls (P value <0.001). It also showed that acute cases had statistically significant higher serum levels of Tenascin-c than chronic cases (P value <0.001). This indicates that serum Tenascin-C level is elevated in cases of acute dilated cardiomyopathy and is decreased significantly in chronic DCM. And showed that circulating tenascin-C is generally associated with the severity of left ventricular dysfunction. Conclusions: Serum-Tenascin Level was significantly increased in patients with idiopathic dilated cardiomyopathies. This increase was noted in acute and chronic cases, with significant difference between both being higher in the acute cases, and associated with the severity of heart failure and the LV dysfunction as detected by 2D speckle tracking echocardiography.

Keywords

• Tenascin-C
• Dilated cardiomyopathy
• 2D speckle tracking echocardiography