MicroRNA-21 and MicroRNA-208a as Biomarkers of Myocardial Remodeling Post-Infarction
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Myocardial remodeling following acute myocardial infarction (AMI) is a critical determinant of long-term cardiac function and progression to heart failure. Conventional biomarkers provide limited insight into the molecular mechanisms underlying this process. MicroRNAs (miRNAs), particularly microRNA-21 (miR-21) and microRNA-208a (miR-208a), have emerged as potential regulators of fibrosis and myocardial injury, respectively, and may serve as novel biomarkers of post-infarction remodeling. Methods This prospective observational study was conducted at two tertiary centers in Italy and included 60 patients with confirmed AMI and 20 healthy controls. Plasma levels of miR-21 and miR-208a were measured using quantitative real-time PCR at admission (T0), 72 hours (T1), and 3 months (T2). Echocardiographic assessment of left ventricular function and volumes was performed at baseline and 3-month follow-up. Adverse remodeling was defined as a ≥20% increase in left ventricular end-diastolic volume. Statistical analysis included correlation studies, receiver operating characteristic (ROC) curve analysis, and multivariate logistic regression. Results Both miR-21 and miR-208a levels were significantly elevated in AMI patients compared to controls (p < 0.001). MiR-21 peaked at 72 hours (5.2 ± 1.6-fold increase), while miR-208a showed highest levels at admission (4.5 ± 1.5-fold). Adverse remodeling occurred in 36.7% of patients. MiR-21 levels were significantly higher in patients with remodeling (5.9 ± 1.4 vs 3.7 ± 1.1; p < 0.001) and showed strong correlations with left ventricular ejection fraction (r = −0.62) and LVEDV (r = 0.58). MiR-208a correlated with troponin levels (r = 0.65, p < 0.001) and remodeling status (p = 0.002). ROC analysis demonstrated good predictive performance for miR-21 (AUC = 0.87) and miR-208a (AUC = 0.82), with improved accuracy when combined (AUC = 0.91). Multivariate analysis identified miR-21 and miR-208a as independent predictors of remodeling. Conclusion Circulating miR-21 and miR-208a are promising non-invasive biomarkers for assessing myocardial remodeling following AMI. MiR-21 is strongly associated with fibrotic remodeling, whereas miR-208a reflects myocardial injury severity. Their combined use enhances predictive accuracy and may support early risk stratification and personalized management of patients with post-infarction conditions. Keywords: MicroRNA-21; MicroRNA-208a; Myocardial Infarction; Cardiac Remodeling; Biomarkers; Left Ventricular Dysfunction; Fibrosis.
Authors: Alessandro Conti, Francesca Rinaldi
Institutions: Sapienza University of Rome, University of Milan
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7154728936
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