Patient Management in Aortic Stenosis: Towards Precision Medicine through Protein Analysis, Imaging and Diagnostic Tests

Abstract

Aortic stenosis is the most frequent valvular disease in developed countries. It progresses from mild fibrocalcific leaflet changes to a more severe leaflet calcification at the end stages of the disease. Unfortunately, symptoms of aortic stenosis are unspecific and only appear when it is too late, complicating patients’ management. The global impact of aortic stenosis is increasing due to the growing elderly population. The disease supposes a great challenge because of the multiple comorbidities of these patients. Nowadays, the only effective treatment is valve replacement, which has a high cost in both social and economic terms. For that reason, it is crucial to find potential diagnostic, prognostic and therapeutic indicators that could help us to detect this disease in its earliest stages. In this article, we comprehensively review several key observations and translational studies related to protein markers that are promising for being implemented in the clinical field as well as a discussion about the role of precision medicine in aortic stenosis.

Diabetes Mellitus and Its Implications in Aortic Stenosis Patients

“…For example, the diagnosis of T2DM is based on glucose and haemoglobin A1c levels. There has been little research into AS biomarkers, although some proteomic studies have been carried out using animal models and different human samples, such as AV tissue or plasma [89]. Several metabolomics studies have been carried out in recent years and some of these even combined metabolomics and proteomics, highlighting the involvement of inflammation, lipid metabolism, coagulation and haemostasis, extracellular matrix remodelling, and oxidative stress [90,91].…”

Prioritization of Candidate Biomarkers for Degenerative Aortic Stenosis through a Systems Biology-Based In-Silico Approach

“…The appearance of its most common symptoms, such as dyspnea, angina, and syncope, predict a rapid deterioration of left ventricular function and the development of heart failure, potentially provoking the death of the patient if the pathology progresses. The only effective treatment to avoid this and improve survival is AV replacement, either surgically or via a transcatheter, which makes the management of these patients difficult [4,5]. As surgery should only be performed when the risks of AS outweigh those of the intervention, it is important to define different indicators to stratify the risk and timing of such interventions [6].…”