Background -Disintegrin metalloproteinases(ADAMs) may contribute to structural cardiac remodeling by altering cell-surface matrix receptors(integrins) and activating potent biomolecules. We compared expression of ADAMs, their endogenous inhibitor tissue inhibitor of metalloproteinases(TIMP)-3, and integrins in human heart tissue with varied patterns of structural remodeling. Methods and Results -Myocardium was obtained from patients with dilated cardiomyopathy(n=20), hypertrophic obstructive cardiomyopathy(n=5), and nonfailing donor hearts(n=7). Paired samples(n=10) were obtained before left ventricular assist device insertion and at transplantation. The expressions of ADAM10, ADAM12, ADAM15, and ADAM17, TIMP-3, and integrin receptors β1D and β3 were determined by quantitative immunoblotting. Integrin shedding was assessed by the ratio of integrin cleavage products to intact protein abundance. Confocal microscopy was performed. Dilated cardiomyopathy was characterized by increased ADAM10 and ADAM15 expression and reduced TIMP-3 expression. The integrin β1D cleavage ratio was elevated, indicating receptor shedding. ADAM10 and ADAM15 expressions correlated with the cleavage ratio. ADAM10 colocalized with integrin β1D by confocal microscopy. ADAM10 expression correlated with clinical indices of chamber dilatation and systolic dysfunction. Hemodynamic unloading reduced ADAM10 and ADAM12 expressions and increased integrin β1D expression. ADAM12 and integrin β1D expressions were increased in HOCM. ADAM17 was increased in both dilated cardiomyopathy and hypertrophic obstructive cardiomyopathy. Conclusions -Disintegrin metalloproteinases are differentially expressed in human myocardium, reflecting the underlying pattern of structural remodeling. ADAM10 and ADAM15 may contribute to cardiac dilatation by reducing cell-matrix interactions via integrin shedding. Targeting disintegrin metalloproteinases, perhaps by restoring deficient TIMP-3 levels with gene or cell-based therapies, may prevent progressive chamber dilatation in human dilated cardiomyopathy. Background -Disintegrin metalloproteinases (ADAMs) may contribute to structural cardiac remodeling by altering cell-surface matrix receptors (integrins) and activating potent biomolecules. We compared expression of ADAMs, their endogenous inhibitor tissue inhibitor of metalloproteinases (TIMP) -3, and integrins in Methods and Results-Myocardium was obtained from patients with dilated cardiomyopathy (n = 20), hypertrophic obstructive cardiomyopathy (n = 5), and nonfailing donor hearts (n = 7) The expressions of ADAM10, ADAM12, ADAM15, and ADAM17, TIMP-3, and integrin receptors β1D and β3 were determined by quantitative immunoblotting. Integrin shedding was assessed by the ratio of integrin cleavage products to intact protein abundance. Confocal microscopy was performed. Dilated cardiomyopathy was characterized by increased AD ADAM10 and ADAM15 expressions correlated with the cleavage ratio. ADAM10 colocalized with integrin β1D by confocal microscopy. ADAM10 expression correlated with clinical indices of chamber ADAM17 was increased in both dilated cardiomyopathy and hypertrophic obstructive cardiomyopathy. Conclusions-Disintegrin metalloproteinases are differentially expressed in human myocardium , suggesting the underlying pattern of structural remodeling. ADAM10 and ADAM15 may contribute to cardiac dilatation by reducing cell-matrix interactions via integrin shedding. Targeting disintegrin metalloproteinases, perhaps by restoring deficient TIMP-3 levels with gene or cell-based therapies, may prevent progressive chamber dilatation in human dilated cardiomyopathy.