OBJECTIVES We sought to elucidate how the local activation of matrix metalloproteinases (MMPs) is balanced by that of the endogenous tissue inhibitors of MMP (TIMPs) during left ventricular (LV) remodeling. BACKGROUND Although it is known that the extracellular matrix (ECM) must be altered during I,V remodeling, its local regulation has not been fully elucidated. METHODS In Dahl salt-sensitive rats with hypertension, in which a stage of concentric, compensated left, ventricular hypertrophy (LVH) at 11 weeks is followed by a distinct stage of congestive heart failure (CHF) with LV enlargement and dysfunction at 17 weeks we determined protein and messenger ribonucleic acid (mRNA) levels of LV myocardial TIMP-2 and -4 and MMP-2, as well as their concomitant activities. RESULTS No changes were found at the LVH stage, However, during the transition to Cl IF, TIMP-2 and -4 activities, protein and mRNA levels were all sharply increased, At the same time, the MMP-2 mRNA and protein levels and activities, as determined by gelatin zymography, as well as by an antibody capture assay, showed a substantial increase during the transition to CHF. The net MMP activities were closely related to increases in LV diameter (r = 0.703) and to systolic wall stress (r = 0.858) in vivo. CONCLUSIONS Both TIMPs and MMP-2 remained inactive during hypertrophy, per se: they were activated during the transition to CHF. At this time, the activation of MMP-2 surpassed that of TIMPs, possibly resulting in ECM breakdown and progression of I,V enlargement. (J Am Coll Cardiol 2002;39:1384-91) (C) 2002 by the American College of Cardiology Foundation.