Review
Usefulness of Circulating Biomarkers for the Prediction of Left Ventricular Remodeling After Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2012.02.069Get rights and content

Left ventricular (LV) remodeling after myocardial infarction (MI) indicates a high risk of heart failure and death, but LV remodeling remains difficult to predict. Biomarkers may help to refine risk stratification for a more personalized medical approach. They may also shed light on the pathophysiologic processes involved. We performed a systematic review of the published evidence about the association of circulating biomarkers with LV remodeling after MI. We selected 59 publications. Overall, these studies examined 112 relations between 52 different biomarkers and LV remodeling. The biomarkers most consistently associated with LV remodeling were involved in extracellular matrix turnover or neurohormonal activation: matrix metalloproteinase-9, collagen peptides, and B-type natriuretic peptide. This review underscores the vitality of the research on LV remodeling but concludes that the ideal biomarker has not yet been identified. To reach this goal, future studies will have to be larger, have standardized imaging end points, and include replication populations to define optimal cutoffs for LV remodeling prediction. Cardiovascular magnetic resonance appears to be the best technique for LV remodeling assessment but its current availability may be a concern for recruitment for multicenter studies. Recent technologic advances will probably yield new candidate biomarkers of LV remodeling. Tests are necessary to determine whether a multimarker approach would significantly improve risk prediction.

Section snippets

Methods

We conducted a computerized Medline search of published articles through November 2011. We searched for “ventricular remodeling AND myocardial infarction,” “ventricular remodeling AND biomarkers,” and “myocardial infarction AND heart failure AND biomarkers.” Bibliographies of all relevant articles were searched manually for additional articles. Next, we performed a computerized search of the Journal Citation Reports through November 2011 to retrieve all articles citing any of the articles

Results

We selected and reviewed 59 publications. Three were published from 1996 to 2000, 13 from 2001 to 2005, and 43 from 2006 through 2011. Table 1 presents data about the relation between biomarkers and LV remodeling. In all, these studies examined 112 relations between 52 different biomarkers and LV remodeling. A positive correlation between biomarker levels and LV remodeling was reported in 63% of cases, a negative correlation was reported in 4%, and no correlation in 33%. Several candidate

Discussion

This systematic overview shows that a relatively large number of potential biomarkers have been studied in relation to LV remodeling after MI. Although several have been repeatedly studied in independent cohorts, many candidates have been analyzed only in single studies, and it is thus more difficult to generalize their results. Moreover, it must be recognized that most studies were of relatively small size; as presented in Table 1, the associations were often tested in cohorts with <100

Acknowledgment

We thank Jo Ann Cahn for improving the English-language report.

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    This work was supported by Grant ANR-11-EMMA-029-01 from ANR, Paris, France. Dr. Fertin was a recipient of a Fédération Francaise de Cardiologie, Paris, France/Société Francaise de Cardiologie, Paris, France fellowship.

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