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Clinical and Biomarker Predictors of Adverse Left Ventricular Remodeling After First STEMI: Insights into Phenotype
Agneta Virbickiene1,2, Vacis Tatarunas1, Ieva Ciapiene1
1Institute of Cardiology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
Pharmaceuticals (Basel, Switzerland)
|May 27, 2026
Summary
Lower platelet count and 20-hydroxyeicosatetraenoic acid (20-HETE) levels on the morning after reperfusion therapy predict adverse left ventricular remodeling (ALVR) after ST-segment elevation myocardial infarction (STEMI). These findings may help identify high-risk patients early.
Area of Science:
- Cardiology
- Biomarkers
- Myocardial Infarction
Background:
- Adverse left ventricular remodeling (ALVR) is a significant complication post-ST-segment elevation myocardial infarction (STEMI), even with timely reperfusion.
- Early identification of patients at risk for unfavorable remodeling is crucial.
- Thromboinflammatory and eicosanoid pathways may offer predictive biomarkers.
Purpose of the Study:
- To assess the association between early circulating biomarkers (platelet count, 20-HETE, 15(S)-HETE, NETosis activity) and cardiac magnetic resonance (CMR)-defined ALVR after STEMI.
- To investigate the predictive value of these biomarkers measured the morning after reperfusion therapy.
Main Methods:
- Prospective study of 93 first STEMI patients treated with reperfusion therapy.
- Serial CMR scans at baseline (median 4 days post-PCI) and 6 months to define ALVR (≥12% increase in LV volumes).
- Blood samples analyzed for platelet count, 20-HETE, 15(S)-HETE, and NETosis activity post-reperfusion.
Main Results:
- ALVR occurred in 20.4% of patients.
- Lower baseline platelet count and 20-HETE levels were independently associated with ALVR (p=0.015 and p=0.047, respectively).
- 20-HETE demonstrated the highest discriminatory ability for ALVR (AUC 0.713), followed by platelet count (AUC 0.670).
Conclusions:
- Reduced platelet count and 20-HETE levels measured early after reperfusion are linked to subsequent CMR-defined ALVR in STEMI patients.
- Platelet count offers a simple clinical risk marker.
- 20-HETE highlights the potential role of eicosanoid pathways in cardiac remodeling post-STEMI.
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