Distinct Biomarker Signatures of CMR-Defined Myocardial Remodeling in Moderate Aortic Stenosis

In 89 patients with moderate aortic stenosis, NT-proBNP, TIMP-1, Galectin-3, and sST2 show distinct, CMR-defined myocardial remodeling associations, with 6 of 20 surviving multiple-testing correction.

• Why it matters: Moderate aortic stenosis outcomes vary despite similar valve hemodynamics, and it is unclear which circulating biomarkers reflect CMR-defined myocardial stress, injury, and fibrosis.
• What they did: Patients underwent CMR with cine imaging, T1 mapping, extracellular volume fraction, and late gadolinium enhancement alongside NT-proBNP, high-sensitivity troponin T, sST2, TIMP-1, and Galectin-3; associations were adjusted for age, sex, renal function and corrected for multiple testing.
• The result: NT-proBNP tracked LV mass index (beta=0.50), ECV (beta=0.35), and LGE burden (beta=0.43, all q<0.05), TIMP-1 and Galectin-3 associated with native T1 (both beta=0.35, q=0.012), and sST2 inversely associated with LV mass index (beta=-0.27, q=0.046); TIMP-1 (OR 2.18 per SD) and NT-proBNP (OR 2.10) increased with higher hierarchical remodeling phenotype, with no biomarker linked to echocardiographic valve hemodynamics after correction.