Novel cardiac extracellular matrix biomarkers in STEMI: Associations with ischemic injury and long-term mortality

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.