The Value of Circulating Biomarkers in Bicuspid Aortic Valve-Associated Aortopathy

Abstract

Traditional risk stratification model of bicuspid aortic valve (BAV) aortopathy is based on measurement of maximal cross-sectional aortic diameter, definition of proximal aortic shape, and aortic stiffness/elasticity parameters. However, conventional imaging-based criteria are unable to provide reliable information regarding the risk stratification in BAV aortopathy, especially considering the heterogeneous nature of BAV disease. Given those limitations of conventional imaging, there is a growing clinical interest to use circulating biomarkers in the screening process for thoracic aortic aneurysms as well as in the risk-assessment algorithms. We aimed to systematically review currently available biomarkers, which may be of value to predict the natural evolution of aortopathy in individuals with BAV.

Blood biomarkers in patients with bicuspid aortic valve disease

“…There has been attention for biomarkers in BAV-associated aortic pathology, focusing on matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinase (TIMP), and TGF-ß [6,40]. Although TGF-ß also seems to be important in thoracic aortic aneurysm development in BAV [41], we did not find an association between serum TGF-ß1 levels and aortic diameter in BAV patients.…”

“…Circulating blood biomarkers might provide additional information to determine who is at highest risk for future complications. Currently, there are limited data on the use of biomarkers in patients with BAV and the data that are available mainly focus on aortapathology [6]. It is of great interest to obtain further insight into alterations of growth factors and mediators in aortic valve degeneration, aortic dilatation, or myocardial remodeling.…”

The impact of the aortic cusps fusion pattern and valve disease severity on the aortic wall mechanics in patients with bicuspid aortic valve

“…Emerging blood biomarkers of aortic wall damage in BAV are metalloproteinases (MMPs)-proteolytic enzymes capable of degrading extracellular matrix components of aortic media and tissue inhibitors of metalloproteinases (TIMPs),as well as transforming growth factor ß (TGF-ß) and specific microRNAs implicated in pathophysiology of aortic wall remodeling [34].…”

Indexed Aortic Area in Bicuspid Valve Disease

“…Although such goals may seem far out of reach, the potential for using magnetic resonance imaging with specific contrast agents targeting key structural components of the aortic wall or some combination of imaging with risk stratification based on genetics associated with BAV aortopathy or the use of circulating biomarkers that have been recently reviewed and proposed for BAV aortopathy prediction exists. 14,15 Although the maturation of such techniques and subsequent integration into mainstream practice holds promise, the current analysis by Masri et al 5 allows the field to move forward toward better risk prediction, thereby enabling more informed clinical decisionmaking. Ultimately though, for these data to be truly impactful, adjusted aortic area to guide surgical intervention needs to be validated prospectively in a randomized multicenter trial showing improved clinical outcomes when compared with the traditional approach of using nonindexed aortic.…”