Longitudinal assessment of endothelial glycocalyx in ST-elevation myocardial infarction: Interplay with oxidative stress and inflammation

Microvascular dysfunction (MVD) after ST-elevation myocardial infarction (STEMI) is common and contributes to adverse left ventricular remodeling and reduced survival. Endothelial glycocalyx (eGC) shedding during STEMI has been proposed as a potential mechanism for MVD. This study evaluated eGC shedding during STEMI, its recovery over time, and its correlations with oxidative stress, inflammation, and endothelial injury. In this before–after clinical study, STEMI patients were assessed in the acute phase and again six months later. Circulating biomarkers of eGC shedding (syndecan-1 [SDC-1], hyaluronan [HYAL], sulfated glycosaminoglycans [GAGs]); endothelial injury (thrombomodulin [TBML], tissue plasminogen activator [tPA], vascular endothelial growth factor [VEGF], nitrite); oxidative stress (malondialdehyde [MDA], total hydroperoxides [H₂O₂], superoxide dismutase [SOD], reduced glutathione [GSH], total antioxidant capacity [TAC]); and inflammatory mediators (IL-6, TNF-α) were quantified. Sublingual microcirculation was evaluated using GlycoCheck to estimate the perfused boundary region (PBR), an inverse parameter of eGC thickness. Twenty patients were included, with a mean interval of 188 ± 31 days between assessments. PBR and flow-adjusted PBR decreased significantly from the acute phase to follow-up, indicating eGC restoration. Acute elevations in SDC-1, HYAL, GAGs, MDA, H₂O₂, SOD, tPA, and nitrite were attenuated at six months. Biomarkers of eGC shedding and PBR values correlated positively with indices of oxidative stress, endothelial injury and inflammation. eGC shedding occurs during STEMI and shows evidence of recovery in the subsequent months. Correlations between eGC shedding and oxidative stress, endothelial injury and inflammation support a mechanistic interplay contributing to MVD development after STEMI. • Microvascular dysfunction (MVD) is common in ST-elevation myocardial infarction (STEMI). • Endothelial glycocalyx (eGC) shedding occurs in STEMI, followed by later reconstitution. • eGC shedding correlates with oxidative stress, inflammation, and endothelial cell injury. • eGC shedding may play a pivotal role in the MVD development following STEMI.