{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:42:28Z","timestamp":1785436948289,"version":"3.56.0"},"reference-count":27,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Instituto de Salud Carlos III and Fondos Europeos de Desarrollo Regional FEDER","award":["PI23\/01150"],"award-info":[{"award-number":["PI23\/01150"]}]},{"name":"Instituto de Salud Carlos III and Fondos Europeos de Desarrollo Regional FEDER","award":["INT25\/00085"],"award-info":[{"award-number":["INT25\/00085"]}]},{"name":"Instituto de Salud Carlos III and Fondos Europeos de Desarrollo Regional FEDER","award":["JR23\/00032"],"award-info":[{"award-number":["JR23\/00032"]}]},{"name":"Instituto de Salud Carlos III and Fondos Europeos de Desarrollo Regional FEDER","award":["CB16\/11\/00403"],"award-info":[{"award-number":["CB16\/11\/00403"]}]},{"name":"Instituto de Salud Carlos III and Fondos Europeos de Desarrollo Regional FEDER","award":["CB16\/11\/00420"],"award-info":[{"award-number":["CB16\/11\/00420"]}]},{"name":"Instituto de Salud Carlos III and Fondos Europeos de Desarrollo Regional FEDER","award":["CB16\/11\/00486"],"award-info":[{"award-number":["CB16\/11\/00486"]}]},{"award":["PI23\/01150"],"award-info":[{"award-number":["PI23\/01150"]}],"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"award":["INT25\/00085"],"award-info":[{"award-number":["INT25\/00085"]}],"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"award":["JR23\/00032"],"award-info":[{"award-number":["JR23\/00032"]}],"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"award":["CB16\/11\/00403"],"award-info":[{"award-number":["CB16\/11\/00403"]}],"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"award":["CB16\/11\/00420"],"award-info":[{"award-number":["CB16\/11\/00420"]}],"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"award":["CB16\/11\/00486"],"award-info":[{"award-number":["CB16\/11\/00486"]}],"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["CIPROM\/2024\/028"],"award-info":[{"award-number":["CIPROM\/2024\/028"]}]},{"name":"Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["CIAPOS\/2023\/247"],"award-info":[{"award-number":["CIAPOS\/2023\/247"]}]},{"name":"Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["CIACIF\/2023\/482"],"award-info":[{"award-number":["CIACIF\/2023\/482"]}]},{"award":["CIPROM\/2024\/028"],"award-info":[{"award-number":["CIPROM\/2024\/028"]}],"id":[{"id":"https:\/\/ror.org\/0097mvx21","id-type":"ROR","asserted-by":"publisher"}]},{"award":["CIAPOS\/2023\/247"],"award-info":[{"award-number":["CIAPOS\/2023\/247"]}],"id":[{"id":"https:\/\/ror.org\/0097mvx21","id-type":"ROR","asserted-by":"publisher"}]},{"award":["CIACIF\/2023\/482"],"award-info":[{"award-number":["CIACIF\/2023\/482"]}],"id":[{"id":"https:\/\/ror.org\/0097mvx21","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Early circulating biomarkers capable of identifying patients at risk for impaired recovery of left ventricular (LV) systolic function after ST-segment elevation myocardial infarction (STEMI) remain limited. This exploratory study aims to determine whether serum follistatin measured within the first 24 h after coronary revascularization is associated with long-term LV systolic function, as assessed by cardiac magnetic resonance (CMR). Methods: In this prospective study, 31 patients with reperfused STEMI underwent serial CMR at 1 week and 6 months. Follistatin levels were measured within 24 h after revascularization. Associations between follistatin and CMR-derived LV systolic function were assessed using univariate and multivariable linear regression analyses. Results: Patients were stratified by median follistatin level (438 pg\/mL) into below median (n = 15) and above median (n = 16). At 1 week, CMR-derived LV function, volumes, and structural indices were similar between groups. By 6 months, however, patients with follistatin above the median had higher LV ejection fraction (LVEF) [62 \u00b1 9% vs. 54 \u00b1 9%; p-value = 0.018] and lower LV end-systolic volume index (28 \u00b1 12 vs. 41 \u00b1 18 mL\/m2; p-value = 0.037). In univariate analysis, follistatin was associated with 6-month LVEF (\u03b2 = 0.027 per pg\/mL; p-value = 0.004). After multivariable adjustment, follistatin remained independently associated with 6-month LVEF (\u03b2 = 0.024 per pg\/mL; p-value &lt; 0.001) and with relative improvement in LVEF from 1 week to 6 months (\u03b2 = 0.044 per pg\/mL; p-value &lt; 0.001). Conclusions: In reperfused STEMI patients, higher early follistatin levels were independently associated with more favorable LV systolic function at 6 months. These hypothesis-generating findings suggest that follistatin may represent a potential biomarker of subsequent systolic recovery after STEMI, warranting further validation in larger prospective studies.<\/jats:p>","DOI":"10.3390\/jcm15155777","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:13:17Z","timestamp":1784826797000},"page":"5777","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Follistatin and Systolic Function at Follow-Up in STEMI Patients: A Cardiac Magnetic Resonance Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3483-7066","authenticated-orcid":false,"given":"Jose","family":"Gavara","sequence":"first","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria INCLIVA, 46010 Valencia, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red\u2014Cardiovascular (CIBER-CV), 28029 Madrid, Spain"},{"name":"Instituto del Coraz\u00f3n, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Molina-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Departamento de Medicina, Facultad de Medicina, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"de Dios","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria INCLIVA, 46010 Valencia, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red\u2014Cardiovascular (CIBER-CV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3527-0337","authenticated-orcid":false,"given":"Nerea","family":"Perez-Sol\u00e9","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria INCLIVA, 46010 Valencia, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red\u2014Cardiovascular (CIBER-CV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5565-5547","authenticated-orcid":false,"given":"Victor","family":"Marcos-Garces","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria INCLIVA, 46010 Valencia, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red\u2014Cardiovascular (CIBER-CV), 28029 Madrid, Spain"},{"name":"Servicio de Cardiolog\u00eda, Hospital Cl\u00ednico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1734-0381","authenticated-orcid":false,"given":"Hector","family":"Merenciano-Gonzalez","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria INCLIVA, 46010 Valencia, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red\u2014Cardiovascular (CIBER-CV), 28029 Madrid, Spain"},{"name":"Servicio de Cardiolog\u00eda, Hospital Cl\u00ednico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amparo","family":"Ruiz-Saur\u00ed","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria INCLIVA, 46010 Valencia, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red\u2014Cardiovascular (CIBER-CV), 28029 Madrid, Spain"},{"name":"Departamento de Patolog\u00eda, Facultad de Medicina, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3044-197X","authenticated-orcid":false,"given":"Antoni","family":"Bay\u00e9s-Genis","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red\u2014Cardiovascular (CIBER-CV), 28029 Madrid, Spain"},{"name":"Instituto del 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Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1002\/ehf2.13144","article-title":"Heart failure after myocardial infarction: Incidence and predictors","volume":"8","author":"Stehlik","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Marcos-Garc\u00e9s, V., Bertol\u00edn-Boronat, C., Merenciano-Gonz\u00e1lez, H., Mart\u00ednez Mas, M.L., Climent Alberola, J.I., L\u00f3pez-Bueno, L., Pay\u00e1 Rubio, A., P\u00e9rez-Sol\u00e9, N., R\u00edos-Navarro, C., and de Dios, E. (2025). Left ventricular remodeling after myocardial infarction-pathophysiology, diagnostic approach and management during cardiac rehabilitation. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262210964"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.ijcard.2021.11.050","article-title":"Risk score for early risk prediction by cardiac magnetic resonance after acute myocardial infarction","volume":"349","author":"Perez","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1016\/j.jcmg.2024.03.012","article-title":"Cardiac magnetic resonance evaluation of LV remodeling post-myocardial infarction: Prognosis, monitoring and trial endpoints","volume":"17","author":"Gissler","year":"2024","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.gene.2017.10.017","article-title":"The emerging role of follistatin under stresses and its implications in diseases","volume":"639","author":"Zhang","year":"2018","journal-title":"Gene"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.cyto.2014.06.017","article-title":"Regulation and actions of activin A and follistatin in myocardial ischaemia-reperfusion injury","volume":"69","author":"Chen","year":"2014","journal-title":"Cytokine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"33677","DOI":"10.1038\/srep33677","article-title":"Ramipril attenuates left ventricular remodeling by regulating the expression of activin A-follistatin in a rat model of heart failure","volume":"6","author":"Wei","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1161\/CIRCRESAHA.124.325562","article-title":"Follistatin from hiPSC-cardiomyocytes promotes myocyte proliferation in pigs with postinfarction LV remodeling","volume":"136","author":"Wei","year":"2025","journal-title":"Circ. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.metabol.2017.05.002","article-title":"Circulating irisin levels are lower in patients with either stable coronary artery disease (CAD) or myocardial infarction (MI) versus healthy controls, whereas follistatin and activin A levels are higher and can discriminate MI from CAD with similar to CK-MB accuracy","volume":"73","author":"Anastasilakis","year":"2017","journal-title":"Metabolism"},{"key":"ref_11","first-page":"420","article-title":"Activin A predicts left ventricular remodeling and mortality in patients with ST-elevation myocardial infarction","volume":"32","author":"Lin","year":"2016","journal-title":"Acta Cardiol. Sin."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1002\/jmri.27789","article-title":"Magnetic resonance assessment of left ventricular ejection fraction at any time post-infarction for prediction of subsequent events in a large multicenter STEMI registry","volume":"56","author":"Gavara","year":"2022","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"107490","DOI":"10.1016\/j.intimp.2021.107490","article-title":"Overexpression of genes involved in lymphocyte activation and regulation are associated with reduced CRM-derived cardiac remodelling after STEMI","volume":"95","author":"Gavara","year":"2021","journal-title":"Int. Immunopharmacol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.1007\/s10741-022-10214-0","article-title":"Detection of myocardial fibrosis by speckle-tracking echocardiography: From prediction to clinical applications","volume":"27","author":"Lisi","year":"2022","journal-title":"Heart Fail. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Sonaglioni, A., Nicolosi, G.L., Rigamonti, E., Lombardo, M., and La Sala, L. (2022). Molecular approaches and echocardiographic deformation imaging in detecting myocardial fibrosis. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms231810944"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Legallois, D., Macquaire, C., Hodzic, A., Allouche, S., El Khouakhi, I., Manrique, A., Milliez, P., Saloux, E., and Beygui, F. (2020). Serum neprilysin levels are associated with myocardial stunning after ST-elevation myocardial infarction. BMC Cardiovasc. Disord., 20.","DOI":"10.1186\/s12872-020-01578-y"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ijcard.2018.06.073","article-title":"ST2 and left ventricular remodeling after ST-segment elevation myocardial infarction: A cardiac magnetic resonance study","volume":"270","author":"Chorro","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"244","DOI":"10.5603\/CJ.a2020.0028","article-title":"Lack of prognostic significance for major adverse cardiac events of soluble suppression of tumorigenicity 2 levels in patients with ST-segment elevation myocardial infarction","volume":"28","author":"Kim","year":"2021","journal-title":"Cardiol. J."},{"key":"ref_19","first-page":"208","article-title":"Admission macrophage migration inhibitory factor predicts long-term prognosis in patients with ST-elevation myocardial infarction","volume":"4","author":"Deng","year":"2018","journal-title":"Eur. Heart J. Qual. Care Clin. Outcomes"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"80","DOI":"10.3109\/00365510903518191","article-title":"Plasma YKL-40 and recovery of left ventricular function after acute myocardial infarction","volume":"70","author":"Hedegaard","year":"2010","journal-title":"Scand. J. Clin. Lab. Investig."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Liu, M., Mao, C., Li, J., Han, F., and Yang, P. (2017). Effects of the activin A-follistatin system on myocardial cell apoptosis through the endoplasmic reticulum stress pathway in heart failure. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18020374"},{"key":"ref_22","first-page":"5074","article-title":"Activin A inhibition attenuates sympathetic neural remodeling following myocardial infarction in rats","volume":"17","author":"Hu","year":"2018","journal-title":"Mol. Med. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2804","DOI":"10.1016\/j.jacc.2020.03.074","article-title":"Recovery of left ventricular systolic function and clinical outcomes in young adults with myocardial infarction","volume":"75","author":"Wu","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2549","DOI":"10.1093\/eurheartj\/ehac223","article-title":"Left ventricular remodelling post-myocardial infarction: Pathophysiology, imaging, and novel therapies","volume":"43","author":"Frantz","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e017645","DOI":"10.1161\/CIRCIMAGING.124.017645","article-title":"Clinical impact of persistent microvascular obstruction in CMR after reperfused STEMI","volume":"18","author":"Troger","year":"2025","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"101563","DOI":"10.1016\/j.jacbts.2026.101563","article-title":"Prolonged inflammation associates with greater infarct size and poor outcome after ST-segment elevation myocardial infarction","volume":"11","author":"Graesser","year":"2026","journal-title":"JACC Basic Transl. Sci."},{"key":"ref_27","first-page":"421","article-title":"Radial approach reduces mortality in patients with ST-segment elevation myocardial infarction and cardiogenic shock","volume":"131","author":"Tokarek","year":"2021","journal-title":"Pol. Arch. Intern. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5777\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:32:10Z","timestamp":1784827930000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5777"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":27,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15155777"],"URL":"https:\/\/doi.org\/10.3390\/jcm15155777","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]}}}