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.主动脉瓣狭窄（Aortic stenosis, AS）是成人最常见的心脏瓣膜病之一。当重度主动脉瓣狭窄伴随临床症状出现时，若不实施主动脉瓣置换术（Aortic valve replacement, AVR），患者预后往往较差；但即便主动脉瓣狭窄已达重度，许多患者仍无明显症状。此类患者行主动脉瓣置换术的最佳时机目前仍存在不确定性与争议。主动脉瓣狭窄是一种异质性疾病，其病理生理过程复杂，既涉及瓣膜的结构与生物学改变，也包括心肌与血管系统针对慢性压力负荷产生的适应性及失代偿性代偿变化。目前已发现多种可反映上述病理过程的生物标志物，且已证实其可用于预测主动脉瓣置换术前后的症状发作及临床事件。本文系统综述了已在主动脉瓣狭窄领域开展研究的生物标志物，并总结了其在风险分层及最终指导主动脉瓣置换术最佳时机方面的潜在应用价值。