Abstract
The prevalence of heart failure (HF) due to cardiac remodelling after acute myocardial infarction (AMI) does not decrease regardless of implementation of new technologies supporting opening culprit coronary artery and solving of ischemia-relating stenosis with primary percutaneous coronary intervention (PCI). Numerous studies have examined the diagnostic and prognostic potencies of circulating cardiac biomarkers in acute coronary syndrome/AMI and heart failure after AMI, and even fewer have depicted the utility of biomarkers in AMI patients undergoing primary PCI. Although complete revascularization at early period of acute coronary syndrome/AMI is an established factor for improved short-term and long-term prognosis and lowered risk of cardiovascular (CV) complications, late adverse cardiac remodelling may be a major risk factor for one-year mortality and postponded heart failure manifestation after PCI with subsequent blood flow resolving in culprit coronary artery. The aim of the review was to focus an attention on circulating biomarker as a promising tool to stratify AMI patients at high risk of poor cardiac recovery and developing HF after successful PCI. The main consideration affects biomarkers of inflammation, biomechanical myocardial stress, cardiac injury and necrosis, fibrosis, endothelial dysfunction, and vascular reparation. Clinical utilities and predictive modalities of natriuretic peptides, cardiac troponins, galectin 3, soluble suppressor tumorogenicity-2, high-sensitive C-reactive protein, growth differential factor-15, midregional proadrenomedullin, noncoding RNAs, and other biomarkers for adverse cardiac remodelling are discussed in the review.
Highlights
Heart failure (HF) is a global health problem with serious economic burden that has been considered as the dominant cause of cardiovascular (CV) morbidity and mortality in the developed and developing countries [1, 2]
After a prolonged period of hopes regarding improvement of diagnostic and risk stratification in segment elevation myocardial infarction (STEMI) patients with subsequent percutaneous coronary intervention (PCI) using the combined biomarker models [101], it has clearly become what large clinical trials need to evaluate diagnostic and predictive values of various combinations of biomarkers, because the evidence of previous studies in acute myocardial infarction (AMI) patient treated with PCI appeared to be controversial [102, 103]
Hs-TnT or hs-TnI added to NT-proBNP and suppression of tumorigenicity-2 (sST2) appears to be emerging biomarkers in the prediction of adverse outcome of HF after AMI in a short-term period [115], but whether this combination is most suitable for remote prognostication in patients with known late adverse cardiac remodelling and different phenotypes of ischemiainduced HF is not fully clear
Summary
Heart failure (HF) is a global health problem with serious economic burden that has been considered as the dominant cause of cardiovascular (CV) morbidity and mortality in the developed and developing countries [1, 2]. Increase in quality of life, and delay in progression or reversal of ischemia-induced cardiac remodelling and chronic HF remain prime targets for the treatment of AMI [13, 14], there are no clear approaches for risk stratification in AMI patients after successful PCI [15]. Except for early revascularization, cardiac remodelling could be prevented by pharmacotherapy including complex neurohormonal blockade and device-based therapies, which are addressed in the improvement of ventricular dyssynchrony and prevention from fatal arrhythmias [19]. In this context, new diagnostic and predictive options are needed to prevent cardiac remodelling and HF.
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