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 …