Clinical Implications of Serum Biomarkers of Cardiac Stress in Aortic Stenosis
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Purpose of Review
The purpose of this review is to outline the relationship between serum biomarkers of cardiac stress and the pathophysiologic progression of aortic stenosis, to identify studies exploring the utility of biomarkers in the risk stratification and management of patients with aortic stenosis, and to highlight the biomarkers most practical to management of patients with aortic stenosis.
Several biomarkers have been identified that reflect various aspects of the pathogenesis of calcific aortic stenosis, subsequent hemodynamic obstruction leading to myocardial remodeling, oxidative stress and injury, and concomitant systemic inflammation. These markers are associated with adverse outcomes in aortic stenosis and offer incremental value in risk prediction over traditional clinical assessment for aortic stenosis. NTproBNP and troponin are the most rigorously studied serum biomarkers in aortic stenosis, and only NTproBNP is currently reflected in any major guideline on aortic stenosis management.
Serum biomarkers show promise in guiding management of aortic stenosis, but still require significant prospective investigation before they can be incorporated in major guidelines.
KeywordsSerum biomarkers Heart failure Aortic stenosis
Compliance with Ethical Standards
Conflict of Interest
Nimesh Patel declares no potential conflicts of interest.
Dharam J. Kumbhani reports honoraria from the American College of Cardiology.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 2.Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:2440–92.CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Otto CM, Kumbhani DJ, Alexander KP, Calhoon JH, Desai MY, Kaul S, et al. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2017;69:1313–46.CrossRefPubMedGoogle Scholar
- 8.• Redfors B, Furer A, Lindman BR, Burkhoff D, Marquis-Gravel G, Francese DP, et al. Biomarkers in aortic stenosis: a systematic review. Structural Heart. 2017;1:18–30. A detailed systematic review of the biomarkers of cardiac stress that have been studied in patients with aortic stenosis.CrossRefGoogle Scholar
- 9.• Lindman BR, Breyley JG, Schilling JD, Vatterott AM, Zajarias A, Maniar HS, et al. Prognostic utility of novel biomarkers of cardiovascular stress in patients with aortic stenosis undergoing valve replacement. Heart. 2015;101:1382–8. A prospective registry study that assesses the utility of multiple biomarkers of cardiovascular stress in predicting mortality after aortic vale replacement independent of clinical risk factors.CrossRefPubMedPubMedCentralGoogle Scholar