Targeted metabolomic profiling of myocardial remodeling after STEMI

Early detection of myocardial remodeling is essential for optimizing outcomes in patients with ST-segment elevation myocardial infarction (STEMI). However, reliable biomarkers for predicting STEMI myocardial remodeling remain scarce.
Targeted metabolomic profiling was performed on plasma samples from 61 STEMI patients: six patients with anterior STEMI with remodeling, 26 patients with anterior STEMI without remodeling and 29 patients with inferior STEMI. Quantitative analysis included 87 endogenous metabolites.
Several metabolite classes were identified as informative markers of STEMI myocardial remodeling. It was found, that nine metabolites had significant differences in STEMI patients with remodeling and without remodeling. Collagenogenic amino acids (proline, lysine) showed a marked elevation on baseline and may reflect early fibrotic activity. Gamma-aminobutyric acid and cystationine had demonstrated a strong correlation with left ventricle wall thickness and fibrous ring of the mitral valve. Branched-chain amino acids (valine) showed a significant decrease that may suggest a shift in energy metabolism in STEMI. ADMA was increased significantly in patients with remodeling which may be linked to cellular damage and impaired nitric oxide signaling. Decreased acylcarnitine (C0) indicates mismatch between fatty acid mobilization and mitochondrial oxidation in STEMI patients with remodeling. Thus, increased proline, decreased GABA and C0 levels, as well as increased ADMA : Gly, ADMA : Ser, Ala : Glu ratios may be a potential biochemical predictors of myocardial remodeling, which may be considered as a target for a future therapeutic approach.
This study highlights key metabolic alterations associated with STEMI myocardial remodeling. Taken together, these insights offer a promising foundation for the development of robust, minimally invasive, and potentially automatable blood-based tools for early prediction of myocardial remodeling.