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

PLoS One. 2024 May 13;19(5):e0302732. doi: 10.1371/journal.pone.0302732. eCollection 2024.


Background: We aimed to determine whether serum levels of proteins related to changes in cardiac extracellular matrix (ECM) were associated with ischemic injury assessed by cardiac magnetic resonance (CMR) and mortality in patients with ST-elevation myocardial infarction (STEMI).

Methods: The concentrations of six ECM-related proteins (periostin, osteopontin, syndecan-1, syndecan-4, bone morphogenetic protein 7, and growth differentiation factor (GDF)-15) were measured in serum samples from patients on Day 1 and Month 4 after STEMI (n = 239). Ischemic injury was assessed by myocardial salvage index, microvascular obstruction, infarct size, and left ventricular function measured by CMR conducted during the initial admission (median 2 days after admission) and after 4 months. All-cause mortality was recorded after a median follow-up time of 70 months.

Results: Levels of periostin increased from Day 1 to Month 4 after hospitalization, while the levels of GDF-15, osteopontin, syndecan-1, and syndecan-4 declined. At both time points, high levels of syndecan-1 were associated with microvascular obstruction, large infarct size, and reduced left ventricular ejection fraction, whereas high levels of syndecan-4 at Month 4 were associated with a higher myocardial salvage index and less dilatation of the left ventricle. Higher mortality rates were associated with periostin levels at both time points, low syndecan-4 levels at Month 4, or high GDF-15 levels at Month 4.

Conclusions: In patients with STEMI, we found an association between serum levels of ECM biomarkers and ischemic injury and mortality. The results provide new insight into the role ECM components play in ischemic injury following STEMI and suggests a potential for these biomarkers in prognostication after STEMI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers* / blood
  • Extracellular Matrix / metabolism
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardium / metabolism
  • Myocardium / pathology
  • Osteopontin / blood
  • ST Elevation Myocardial Infarction* / blood
  • ST Elevation Myocardial Infarction* / mortality


  • Biomarkers
  • Osteopontin

Grants and funding

This work was supported by: SA South-Eastern Health Authorities Grant number 2020073 MV Norwegian Health Association. Grant number 12912 The funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.