Abstract
The optimal timing of aortic valve replacement (AVR) remains controversial. Several biomarkers reflect the underlying pathophysiological processes in aortic stenosis (AS) and may be of use as mortality predictors. The aim of this systematic review and meta-analysis is to evaluate the blood biomarkers utilised in AS and assess whether they associate with mortality. PubMed and Embase were searched for studies reporting baseline biomarker level and mortality outcomes in patients with AS. A total of 83 studies met the inclusion criteria and were systematically reviewed. Of these, 21 reporting brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), Troponin and Galectin-3 were meta-analysed. Pooled analysis demonstrated that all-cause mortality was significantly associated with elevated baseline levels of BNP (HR 2.59; 95% CI 1.95–3.44; p < 0.00001), NT-proBNP (HR 1.73; 95% CI 1.45–2.06; p = 0.00001), Troponin (HR 1.65; 95% CI 1.31–2.07; p < 0.0001) and Galectin-3 (HR 1.82; 95% CI 1.27–2.61; p < 0.001) compared to lower baseline biomarker levels. Elevated levels of baseline BNP, NT-proBNP, Troponin and Galectin-3 were associated with increased all-cause mortality in a population of patients with AS. Therefore, a change in biomarker level could be considered to refine optimal timing of intervention. The results of this meta-analysis highlight the importance of biomarkers in risk stratification of AS, regardless of symptom status.
Highlights
Aortic stenosis (AS) is the most common valvular heart disease in the elderly in Western countries [1,2], with an estimated prevalence of 5–7% in the general population over 65 years [3]
According to the current guidelines, intervention is recommended for patients with symptomatic or rapidly progressing severe aortic stenosis and for asymptomatic patients with significant decline of the left ventricular (LV) ejection fraction (EF) < 50% [4]
2785 studies were excluded after duplicates were removed and studies were assessed for eligibility at the title and abstract level
Summary
Aortic stenosis (AS) is the most common valvular heart disease in the elderly in Western countries [1,2], with an estimated prevalence of 5–7% in the general population over 65 years [3]. A significant increase in blood biomarkers can reflect early decompensation of the disease process, a finding that can be hugely advantageous for decision-making surrounding the optimal timing for intervention. Increased levels of certain biomarkers have been associated with adverse prognosis and increased mortality [6,7,8]. This can be an extremely useful clue in the management of patients with AS, especially useful for those who do not meet conventional criteria for intervention, namely the cohort of patients with asymptomatic severe AS
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