In hypertensive patients with heart failure (HF) a serum biomarker combination of high
carboxy-terminal propeptide of procollagen type-I (PICP) and low carboxy-terminal telopeptide
of collagen type-I to matrix metalloproteinase-1 (CITP:MMP-1) ratio identifies a histomolecular
phenotype of malignant myocardial fibrosis (mMF) associated with severe diastolic dysfunction
(DD) and poor outcomes. As chronic kidney disease (CKD) facilitates MF and DD, we investigated
the influence of CKD on the mMF biomarker combination in HF patients with preserved ejection
fraction (HFpEF). Hypertensives (n = 365), 232 non-HF and 133 HFpEF, were studied, and 35%
non-HF and 46% HFpEF patients had CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2
or urine albumin-to-creatinine ratio ≥ 30 mg/g). Specific immunoassays were performed to determine
biomarkers. Medians were used to establish the high PICP and low CITP:MMP-1 combination.
A comparison with non-HF showed that the biomarker combination presence was increased in
HFpEF patients, being associated with CKD in all patients. CKD influenced the association of
the biomarker combination and HFpEF (p for interaction ≤ 0.019). The E:e’ ratio was associated
with the biomarker combination in CKD patients. Among CKD patients with HFpEF, those with
the biomarker combination exhibited higher (p = 0.016) E:e’ ratio than those without the pattern.
These findings suggest that CKD facilitates the development of biomarker-assessed mMF and DD in
hypertensive HFpEF patients