The role of biomarkers as an alternative and completion of the diagnostic and therapeutic pathway in patients with aortic stenosis

Aortic stenosis (AS) is the most frequent type of valvular heart disease. Clinically, it presents as calcific and congenital AS. Calcific AS is often age dependent and affects 2–7% of people over 65 years of age. Many clinical studies proved high correlation between age and the prevalence of calcific aortic stenosis. According to todays’ knowledge, AS presents not only as simple degenerative disease of the valve, but as an active inflammatory and proliferative process. Better control and evaluation of risk factors might decelerate progression of the disease. It is necessary to increase the knowledge about risk factors and early markers of AS. Echocardiography is the method of choice in the diagnostic course and evaluation of stenosis grade and disease progression, but the role of biomarkers is becoming more and more significant among the clinical evaluation of patients and has been already mentioned in The European Society of Cardiology (ESC) guidelines on the management of valvular heart disease in patients qualified for Aortic Valve Replacement (AVR) with severe, asymptomatic AS, preserved ejection fraction and normal exercise stress test results. The natriuretic peptides level increase at the follow-up measurements is an important co-factor in decision-making. This review article analyses and summarizes the most important research and correlation between calcific aortic valve disease and the biomarkers. The potential clinical implementation of fourteen biomarkers has been reviewed. Echocardiography depends on the operator experience and imaging quality, therefore biomarkers could contribute important information to patients’ diagnosis and follow-up.