Cauwenberghs N, et al. - In a general population including 592 individuals (mean age, 50.8 years; 51.4% women; 40.5% hypertensive), researchers evaluated whether longitudinal changes in left ventricular (LV) structure and function could be predicted by circulating pathophysiologically relevant biomarkers at baseline. At baseline and after 4.7 years, LV structure and function were assessed. They also measured alkaline phosphatase, markers of collagen turnover (procollagen type I, C-terminal telopeptide, matrix metalloproteinase-1) and high-sensitivity cardiac troponin T at baseline. In association with higher baseline alkaline phosphatase activity, a decline in LV longitudinal strain (−14.2%) and increase in E/e′ ratio over time was seen. Higher levels of collagen I production and degradation at baseline were related to decreased longitudinal strain. Higher baseline high-sensitivity cardiac troponin T levels were significantly associated with an increase in relative wall thickness (+23.1%) and LV mass index (+18.3%) during follow-up. Subjects at risk for subclinical cardiac maladaptation might be better detected with circulating biomarkers reflecting LV stiffness, injury, and collagen composition.