Abstract
Pulmonary hypertension (PH) is a serious hemodynamic condition, characterized by increased pulmonary vascular resistance (PVR), leading to right heart failure (HF) and death when not properly treated. The prognosis of PH depends on etiology, hemodynamic and biochemical parameters, as well as on response to specific treatment. Biomarkers appear to be useful noninvasive tools, providing information about the disease severity, treatment response, and prognosis. However, given the complexity of PH, it is impossible for a single biomarker to be adequate for the broad assessment of patients with different types of PH. The search for novel emerging biomarkers is still ongoing, resulting in a few potential biomarkers mirroring numerous pathophysiological courses. In this review, markers related to HF, myocardial remodeling, inflammation, hypoxia and tissue damage, and endothelial and pulmonary smooth muscle cell dysfunction are discussed in terms of diagnosis and prognosis. Extracellular vesicles and other markers with complex backgrounds are also reviewed. In conclusion, although many promising biomarkers have been identified and studied in recent years, there are still insufficient data on the application of multimarker strategies for monitoring and risk stratification in PH patients.
Highlights
We review circulating biomarkers related to different mechanisms underlying the precapillary Pulmonary hypertension (PH) and describe the potential application for them, highlighting their limitations and necessity for further investigation
100 patients diagnosed with PAH or chronic thromboembolic pulmonary hypertension (CTEPH), significant correlations between soluble ST2 (sST2) and cardiac index (CI), mean right atrial pressure, pulmonary vascular resistance (PVR), mvSatO2, NT-proBNP concentration, and 6 min walking distance (6MWD) were noticed [48]
PAH, Growth differentiation factor-15 (GDF-15) was a marker of reduced survival and correlated with NT-proBNP levels and right ventricular systolic pressure assessed by transthoracic echocardiography [73]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The prognosis of PH varies broadly and depends mostly on etiology of PH, but is based on hemodynamic and biochemical parameters, which indicate the severity of right ventricular failure, as well as on response to specific treatment. The main focus is on detecting and quantifying abnormal adaptations and remodeling of the right heart in response to chronic pulmonary circulation impairment. In PH, elevated PVR and PAP lead to hemodynamic stress, myocardial strain, and stretching of the heart. This condition results in the release of the molecular mediators, indicative for numerous cardiovascular diseases with additional prognostic value. Several markers associated with HF, myocardial injury, and myocardial remodeling, such as natriuretic peptides, cardiac troponins, soluble ST2, and heart-type fatty acidbinding protein, have been investigated in a cohort of patients with precapillary PH
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