Salivary Biomarkers for Diagnosis and Therapy Monitoring in Patients with Heart Failure. A Systematic Review.

Aidonis Rammos,Pietro Salvo,Lampros K Michalis,Yorgos Goletsis,Petros Kalogeras,M Giovanna Trivella,Evanthia E Tripoliti,Aris Bechlioulis,Effrosyni Blathra,Abdelhamid Errachid,Dimitrios I Fotiadis,Tommaso Lomonaco,Katerina K Naka,Anna Kalivi,Francesca Bellagambi,Roger Fuoco,Chris J Watson

doi:10.3390/diagnostics11050824

Abstract

The aim of this study was to perform a systematic review on the potential value of saliva biomarkers in the diagnosis, management and prognosis of heart failure (HF). The correlation between saliva and plasma values of these biomarkers was also studied. PubMed was searched to collect relevant literature, i.e., case-control, cross-sectional studies that either compared the values of salivary biomarkers among healthy subjects and HF patients, or investigated their role in risk stratification and prognosis in HF patients. No randomized control trials were included. The search ended on 31st of December 2020. A total of 15 studies met the inclusion criteria. 18 salivary biomarkers were analyzed and the levels of all biomarkers studied were found to be higher in HF patients compared to controls, except for amylase, sodium, and chloride that had smaller saliva concentrations in HF patients. Natriuretic peptides are the most commonly used plasma biomarkers in the management of HF. Their saliva levels show promising results, although the correlation of saliva to plasma values is weakened in higher plasma values. In most of the publications, differences in biomarker levels between HF patients and controls were found to be statistically significant. Due to the small number of patients included, larger studies need to be conducted in order to facilitate the use of saliva biomarkers in clinical practice.

Highlights

IntroductionHeart Failure (HF) is a clinical syndrome characterized by symptoms such as dyspnea or fatigue on exertion or at rest, and clinical signs (i.e., lower extremity oedema, elevated jugular venous pressure, pulmonary crackles, etc.) caused by a structural and/or functional cardiac abnormality, leading to reduced cardiac output [1]
Heart Failure (HF) is a clinical syndrome characterized by symptoms such as dyspnea or fatigue on exertion or at rest, and clinical signs caused by a structural and/or functional cardiac abnormality, leading to reduced cardiac output [1]
The current review aims to assess and summarize the potential role of salivary biomarkers in the diagnosis, progression monitoring and prognosis of patients with heart failure (HF)

Summary

Introduction

Heart Failure (HF) is a clinical syndrome characterized by symptoms such as dyspnea or fatigue on exertion or at rest, and clinical signs (i.e., lower extremity oedema, elevated jugular venous pressure, pulmonary crackles, etc.) caused by a structural and/or functional cardiac abnormality, leading to reduced cardiac output [1]. HF is one of the leading causes of morbidity and mortality worldwide, with a prevalence ranging from 6% to 13% [2]. The classification of HF syndromes currently used in clinical practice for the management of patients is based on the left ventricular ejection fraction (LVEF), rather than the etiology. Patients are characterized as HF with preserved, mid-range and reduced LVEF (HFpEF, HFmrEF and HFrEF when LVEF is ≥50%, 40–49%, and

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