Adverse cardiac remodeling after acute myocardial infarction (MI), regardless of primary percutaneous coronary intervention, is strongly associated with the development of heart failure and poor prognosis. Since demographic and clinical characteristics are not sufficiently sensitive to predict adverse remodeling after MI, more precise parameters are needed to identify individuals at risk of progression to ventricular dysfunction and heart failure, potentially allowing an early and intensive prognosis modifying therapy.

New biomarkers of adverse cardiac remodeling have emerged, such as matrix metalloproteinases (MMP) 2 MMP-2, MMP-6, MMP-9. There is an increasing awareness of the importance of interstitium in the pathophysiology of cardiac diseases beyond cardiac myocytes. In fact, the cardiac interstitium represents one-third of the total myocardial volume. It contains two-thirds of the total number of cells in the myocardium, mainly fibroblasts. Fibroblasts are responsible for maintaining interstitial homeostasis, and the production of MMP. Interstitial expansion is associated with adverse effects on myocardial function in multiple entities.^–

[…]