RESEARCH ARTICLE
Open Access

MicroRNA-21 and MicroRNA-208a as Biomarkers of Myocardial Remodeling Post-Infarction

Alessandro Conti1, Francesca Rinaldi2 ORCID 

1Department of Cardiology, Sapienza University of Rome, Rome, Italy.
2Department of Molecular Medicine, University of Milan, Milan, Italy.
DOI: 10.18081/ajbm.2026.2.82

Publication History: Received 12 December 2025, Revised 04 February 2026, Accepted 30 March 2026, Available online 10 April 2026
Copyright: © 2026 Moreau, et al. This is an open-access article under a Creative Commons license (CC BY 4.0).
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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.

Recommended Citation

Conti A, Rinaldi F. MicroRNA-21 and MicroRNA-208a as Biomarkers of Myocardial Remodeling Post-Infarction. Advanced Journal of Biomedicine & Medicine. 2026;14(1):82-98. doi:10.18081/ajbm.2026.2.82

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Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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Laurent P, Martin S, Moreau J (2026). MicroRNA-21 and MicroRNA-208a as Biomarkers of Myocardial Remodeling Post-Infarction<br /> . Advanced Journal of Biomedicine & Medicine, 14(1), 57-81. https://doi.org/10.18081/ajbm.2026.2.82
Laurent P, Martin S, Moreau J. "MicroRNA-21 and MicroRNA-208a as Biomarkers of Myocardial Remodeling Post-Infarction<br /> ." Advanced Journal of Biomedicine & Medicine, vol. 14, no. 1, 2026, pp. 57-81. DOI: 10.18081/ajbm.2026.2.82.
Laurent P, Martin S, Moreau J. MicroRNA-21 and MicroRNA-208a as Biomarkers of Myocardial Remodeling Post-Infarction<br /> . AJBM. 2026;14(1):57-81. DOI: 10.18081/ajbm.2026.2.82. PMID: .
Laurent P, Martin S, Moreau J 2026, "MicroRNA-21 and MicroRNA-208a as Biomarkers of Myocardial Remodeling Post-Infarction<br /> ", Advanced Journal of Biomedicine & Medicine, vol. 14, no. 1, pp. 57-81.
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Laurent P, Martin S, Moreau J (2026). MicroRNA-21 and MicroRNA-208a as Biomarkers of Myocardial Remodeling Post-Infarction<br /> . Advanced Journal of Biomedicine & Medicine, 14(1), 57-81. https://doi.org/10.18081/ajbm.2026.2.82

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