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Heart Failure Reviews

, Volume 21, Issue 1, pp 25–47 | Cite as

Temporal cardiac remodeling post-myocardial infarction: dynamics and prognostic implications in personalized medicine

  • Raffaele Altara
  • Marco Manca
  • Ramzi Sabra
  • Assaad A. Eid
  • George W. Booz
  • Fouad A. Zouein
Article

Abstract

Despite dramatic improvements in short-term mortality rates following myocardial infarction (MI), long-term survival for MI patients who progress to heart failure remains poor. MI occurs when the left ventricle (LV) is deprived of oxygen for a sufficient period of time to induce irreversible necrosis of the myocardium. The LV response to MI involves significant tissue, cellular, and molecular level modifications, as well as substantial hemodynamic changes that feedback negatively to amplify the response. Inflammation to remove necrotic myocytes and fibroblast activation to form a scar are key wound healing responses that are highly variable across individuals. Few biomarkers of early remodeling stages are currently clinically adopted. The discovery of underlying pathophysiological mechanisms and associated novel biomarkers has the potential of improving prognostic capability and therapeutic monitoring. Combining these biomarkers with other prominent ones could constitute a powerful diagnostic and prognostic tool that directly reflects the pathophysiological remodeling of the LV. Understanding temporal remodeling at the tissue, cellular, and molecular level and its link to a well-defined set of biomarkers at early stages post-MI is a prerequisite for improving personalized care and devising more successful therapeutic interventions. Here we summarize the integral mechanisms that occur during early cardiac remodeling in the post-MI setting and highlight the most prominent biomarkers for assessing disease progression.

Keywords

Cardiac remodeling Myocardial infarction Personalized medicine Biomarkers Inflammation Extracellular matrix 

List of abbreviations

ECM

Extracellular matrix

IL

Interleukin

LV

Left ventricle

MI

Myocardial infarction

MMPs

Matrix metalloproteinases

SPARC

Secreted protein acidic and rich in cysteine

TGFβ

Tumor growth factor beta

VSMC

Vascular smooth muscle cell

α1-PI

Alpha-1 protease inhibitor

α2-MG

Alpha 2-macroglobulin

Notes

Acknowledgments

The authors would like to acknowledge Dr. Abdullah Kaplan for his careful review revisions, and valuable input. The authors appreciate the support of the Department of Pharmacology and Toxicology (UMMC).

Compliance with ethical standards

Conflict of interest

Drs. Raffaele Altara, Marco Manca, Ramzi Sabra, Assaad A. Eid, George W. Booz and Fouad A. Zouein have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Raffaele Altara
    • 1
    • 2
  • Marco Manca
    • 3
  • Ramzi Sabra
    • 4
  • Assaad A. Eid
    • 5
  • George W. Booz
    • 2
  • Fouad A. Zouein
    • 2
    • 4
  1. 1.Department of Physiology and BiophysicsUniversity of Mississippi Medical CenterJacksonUSA
  2. 2.Department of Pharmacology and Toxicology, School of MedicineUniversity of Mississippi Medical CenterJacksonUSA
  3. 3.DG-DI, Medical ApplicationsCERNGenevaSwitzerland
  4. 4.Department of Pharmacology and Toxicology, Faculty of MedicineAmerican University of BeirutBeirutLebanon
  5. 5.Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of MedicineAmerican University of BeirutBeirutLebanon

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