In patients with severe aortic valve stenosis, remodeling processes of the heart muscle play a central role in disease progression. A research team from the German Centre for Cardiovascular Research (DZHK) at the Göttingen site has now shown that these changes can also be detected in the blood.
Aortic valve stenosis is the most common acquired heart valve disease in older age and affects more than 2% of people over 60. With the growing number of catheter-based aortic valve implantations, precise risk assessment is becoming increasingly important.
A key feature of aortic valve stenosis is so-called myocardial fibrosis—a scarring of the heart muscle. It develops over the course of the disease, impairs the heart’s pumping function, and is associated with an unfavorable prognosis.
Limitations of current diagnostics
Until now, the extent of myocardial fibrosis could be most reliably determined through a tissue sample from the heart. However, this procedure is invasive and associated with corresponding risks, creating a need for less burdensome diagnostic approaches.
In the present study, the DZHK team from Göttingen analyzed blood samples from 169 patients with severe aortic valve stenosis who underwent catheter-based valve implantation. The samples were collected before the procedure. In total, the researchers analyzed 184 different serum proteins and examined their relationship with the degree of myocardial fibrosis, systolic heart function, and cardiovascular mortality.
Clear associations between biomarkers, fibrosis, and heart function
The analysis showed that several biomarkers were significantly associated with the degree of myocardial fibrosis. At the same time, there was a relationship between the extent of fibrosis and a reduced left ventricular ejection fraction.
In addition, numerous markers were associated with impaired systolic heart function. Some of these biomarkers—including BNP, NT-proBNP, FGF23, growth hormone, and stem cell factor—showed associations with both myocardial fibrosis and reduced pumping function. They were also linked to cardiovascular mortality.
The study thus identifies, for the first time, serum biomarkers that connect structural changes in the heart muscle, functional impairment, and clinical outcomes in patients with aortic valve stenosis.
The authors emphasize that this is an exploratory, hypothesis-generating study. The results need to be confirmed in larger, prospective trials. In the long term, however, such biomarkers could contribute to improved risk stratification and more individualized treatment decisions.
Original publication:
Gersch S, Ferreira JP, Leha A, et al. Identification of serum biomarkers linking myocardial fibrosis, systolic dysfunction and outcomes in patients with severe aortic stenosis. Cardiovasc Res. Published online March 30, 2026. doi:10.1093/cvr/cvag073
