Circulating biomarkers as predictors of left ventricular remodeling after myocardial infarction

Abstract

Introduction: The main impact of myocardial infarction is shifting from acute mortality to adverse remodeling and chronic left ventricle dysfunction. Several circulating biomarkers are explored for better risk stratification of these patients. Biomarker testing is a very attractive idea, since it is non-invasive, not operator-dependent and widely available.

Aim: In the present paper we analyze data from the years 2005-2020 about circulating biomarkers of remodeling after myocardial infarction.

Material and methods: We assessed 53 articles, which examined 160 relations between biomarkers and remodeling. We analyze inclusion criteria for individual studies, time points of serum collection and remodeling assessment as well as imaging methods.

Results: The main groups of assessed biomarkers included B-type natriuretic peptides, markers of cardiomyocyte injury and necrosis, markers of inflammatory response, markers of extracellular matrix turnover, microRNAs and hormones. The most common method of remodeling assessment was echocardiography and the most frequent time point for remodeling evaluation was 6 months.

Conclusions: The present analysis shows that although a relatively large number biomarkers were tested, selecting one ideal marker is still a challenge. A combination of biomarkers from different groups might be appropriate for predicting remodeling. Data presented in this analysis might be helpful for designing future studies, evaluating clinical use of an individual biomarker or a combination of different biomarkers.

Keywords: biomarkers; combined biomarker testing; myocardial infarction; narrative review; remodeling.

Figure 1

Groups of most commonly assessed biomarkers. Data are shown as number of studies evaluating groups of biomarkers BNP – B type natriuretic peptide, ECM – extracellular matrix.

Figure 2

Relationships between individual biomarkers and remodeling. A – Data are shown as number of studies evaluating specific biomarkers. B – Data are shown as number of patients enrolled in studies evaluating biomarkers BNP – B type natriuretic peptide, Tn – troponin, CRP – C reactive protein, MMP – matrix metalloproteinase, CK – creatinine kinase, TIMP – tissue inhibitor of MMP, PINP – procollagen type I amino terminal propeptide.

Figure 3

Relationships between individual biomarkers and remodeling in patients treated exclusively with primary percutaneous coronary intervention. Data are shown as number of studies evaluating specific biomarkers BNP – B type natriuretic peptide, Tn – troponin, CRP – C reactive protein, MMP – matrix metalloproteinase, CK – creatinine kinase, miR – microRNA, PINP – procollagen type I amino terminal propeptide.