Biomarkers in Aortic Stenosis: A Systematic Review

Aortic stenosis (AS) is one of the most common heart valve diseases among adults. When symptoms develop alongside severe AS, there is a poor prognosis unless aortic valve replacement (AVR) is performed; however, many patients do not report symptoms even when AS is severe. The optimal timing of AVR for these patients remains uncertain and controversial. AS is a heterogeneous disease with a complex pathophysiology involving structural and biological changes of the valve as well as adaptive and maladaptive compensatory changes in the myocardium and vasculature in response to chronic pressure overload. Several biomarkers reflecting these processes have been identified and have shown to have utility in predicting symptom onset and clinical events before and after AVR. Herein we systematically review biomarkers that have been studied in the setting of AS and summarize their potential use for risk stratification and ultimately to guide the optimal timing of AVR.