Role of cardiovascular biomarkers for the assessment of mitral stenosis and its complications

Background: Mitral stenosis (MS) may cause progressive dyspnea on exertion, pulmonary hypertension (PH), atrial fibrillation and right ventricular (RV) failure. Patients with MS presenting with change in dyspnea severity often require a complete cardiologic assessment, but the use of biomarkers may be an alternative for the initial assessment of MS and its complications. The aim of this study was to evaluate the role of several cardiovascular biomarkers for this purpose. Methods: Clinically stable patients with moderate or severe MS were included in this prospective multicenter observational study. ECG, transthoracic echocardiography and biomarker measurement (BNP, MR-proANP and sCD146) were performed at inclusion. One cohort of patients with pre-capillary PH (PAH) was included for comparison of biomarker levels in different etiologies of PH. Results: A total of 117 MS (70% severe, 30% moderate stenosis) were included. Plasma levels of all three biomarkers were higher in severe MS compared to moderate MS. PH was associated with higher levels of BNP and MR-proANP. The presence of atrial fibrillation increased plasma levels of BNP and sCD146, whereas MR-proANP was not affected by atrial fibrillation. PAH patients had higher levels of sCD146 compared to MS patients with PH. RV dysfunction was associated with higher levels of sCD146. Conclusion: MS and its complications affect plasma levels of cardiovascular biomarkers. The use of MR-proANP may be helpful for the assessment of severe stenosis and the presence of PH in the early phase. sCD146 might help identifying patients with more advanced PH and RV-dysfunction. (C) 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.