Aldosterone stimulates cardiac collagen synthesis. Circulating biomarkers of collagen turnover provide a useful tool for the assessment of cardiac remodelling in patients with congestive heart failure (CHF) and left ventricular systolic dysfunction (LVSD) post acute myocardial infarction (AMI).

In a substudy of EPHESUS, which evaluated the effects of the selective aldosterone-receptor antagonist eplerenone versus placebo, serum levels of collagen biomarkers were measured in 476 patients with CHF following AMI complicated with LVSD. Combination of both ICTP and BNP levels above median at baseline was associated with all cause mortality and composite endpoint CV death or HF hospitalisation with hazard ratios of 2.49 (p=0.039) and 3.03 (p=0.002) respectively. During follow up, PINP and PIIINP levels were found consistently lower in the eplerenone group and significantly so from month 6 onwards.

Changes in biomarkers of collagen synthesis and degradation suggest that extra cellular matrix remodelling is an active process in patients with CHF and LVSD post-AMI. High ICTP when combined with high BNP serum levels are associated with the highest event rate. Eplerenone suppresses post-AMI collagen turn over changes.