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Novel cardiac extracellular matrix biomarkers in STEMI: Associations with ischemic injury and long-term mortality
Simon Andrup1,2, Geir Ø Andersen2, Pavel Hoffmann3
1Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Insights
Serum extracellular matrix (ECM) protein levels in ST-elevation myocardial infarction (STEMI) patients correlate with cardiac injury and mortality risk. These biomarkers may aid in predicting patient outcomes after STEMI.
Area of Science:
- Cardiovascular Medicine
- Biomarker Discovery
- Extracellular Matrix Biology
Background:
- Cardiac extracellular matrix (ECM) remodeling is implicated in myocardial infarction.
- Understanding ECM protein changes post-ST-elevation myocardial infarction (STEMI) is crucial for assessing injury and prognosis.
Purpose of the Study:
- To investigate the association between serum ECM-related proteins and ischemic injury.
- To determine the relationship between these biomarkers and mortality in STEMI patients.
Main Methods:
- Serum concentrations of six ECM proteins (periostin, osteopontin, syndecan-1, syndecan-4, BMP-7, GDF-15) were measured in 239 STEMI patients at Day 1 and Month 4 post-STEMI.
- Ischemic injury was assessed using cardiac magnetic resonance (CMR) imaging (myocardial salvage index, microvascular obstruction, infarct size, LV function).
- All-cause mortality was tracked over a median follow-up of 70 months.
Main Results:
- Periostin levels increased, while GDF-15, osteopontin, syndecan-1, and syndecan-4 levels decreased from Day 1 to Month 4.
- High syndecan-1 correlated with microvascular obstruction, larger infarct size, and reduced ejection fraction.
- High periostin, low syndecan-4, and high GDF-15 at Month 4 were associated with increased mortality.
Conclusions:
- Serum ECM biomarkers are associated with the extent of ischemic injury and mortality risk in STEMI patients.
- These findings offer insights into ECM's role in post-STEMI cardiac damage.
- ECM biomarkers show potential for prognostication following STEMI.
Background:
We aimed to determine whether serum levels of proteins related to changes in cardiac extracellular matrix (ECM) were associated with ischemic injury assessed by cardiac magnetic resonance (CMR) and mortality in patients with ST-elevation myocardial infarction (STEMI).
Methods:
The concentrations of six ECM-related proteins (periostin, osteopontin, syndecan-1, syndecan-4, bone morphogenetic protein 7, and growth differentiation factor (GDF)-15) were measured in serum samples from patients on Day 1 and Month 4 after STEMI (n = 239). Ischemic injury was assessed by myocardial salvage index, microvascular obstruction, infarct size, and left ventricular function measured by CMR conducted during the initial admission (median 2 days after admission) and after 4 months. All-cause mortality was recorded after a median follow-up time of 70 months.
Results:
Levels of periostin increased from Day 1 to Month 4 after hospitalization, while the levels of GDF-15, osteopontin, syndecan-1, and syndecan-4 declined. At both time points, high levels of syndecan-1 were associated with microvascular obstruction, large infarct size, and reduced left ventricular ejection fraction, whereas high levels of syndecan-4 at Month 4 were associated with a higher myocardial salvage index and less dilatation of the left ventricle. Higher mortality rates were associated with periostin levels at both time points, low syndecan-4 levels at Month 4, or high GDF-15 levels at Month 4.
Conclusions:
In patients with STEMI, we found an association between serum levels of ECM biomarkers and ischemic injury and mortality. The results provide new insight into the role ECM components play in ischemic injury following STEMI and suggests a potential for these biomarkers in prognostication after STEMI.
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