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Serum biomarkers in valvular heart disease
  1. Syed KM Gardezi1,2,
  2. Sean Coffey3,
  3. Bernard D Prendergast4,
  4. Saul G Myerson1,2
  1. 1Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
  3. 3Department of Medicine, Dunedin School of Medicine, University of Otago, Otago, New Zealand
  4. 4Department of Cardiology, St Thomas’ Hospital, London, UK
  1. Correspondence to Professor Saul G Myerson, Department of Cardiology, John Radcliffe Hospital, Oxford OX3 9DU, UK; saul.myerson{at}cardiov.ox.ac.uk

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Learning objectives

  • Understand the pathophysiological pathways involved in deteriorating valve disease, which may provide useful targets for biomarker development.

  • Understand the currently available serum biomarkers in valve disease and their utility in clinical practice.

  • The potential for future biomarkers, based on the known metabolic and biological pathways.

Introduction

Valvular heart disease (VHD) is an important cause of morbidity and mortality whose prevalence is set to increase dramatically as a consequence of the increase in life expectancy in middle-income and high-income nations. Community echocardiographic screening has identified a major burden of undiagnosed VHD in older people, with some degree of valve degeneration in almost 50% and undiagnosed clinically significant (moderate–severe) disease affecting 1 in 10.1 Population statistics project an increase in the elderly population, such that there will be an estimated 4 million people aged between 75 and 84 years in the UK by 2018, while the population >85 years is set to double by 2028.2 Meanwhile, rheumatic heart disease accounts for a much higher proportion of valve pathology in developing nations and contributes to the growing worldwide prevalence.3 4

Despite wider appreciation of the emerging importance of VHD, the mechanisms underlying its development (particularly in degenerative pathology) are poorly understood, and the role of serum biomarkers in guiding clinical management in individual patients is relatively unexplored. European guidelines5 for the diagnosis and management of VHD make reference to the use of serum B-type natriuretic peptide (BNP) as a marker of prognosis in aortic stenosis (AS) and mitral regurgitation (MR), but thresholds are poorly defined, and there are no definitive recommendations on its use.

As the prevalence of VHD increases, it will be increasingly important to develop our understanding of the factors that determine the rate of progression (allowing the planning of careful and efficient follow-up and timely intervention). A large proportion of …

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