The Role of Cardiovascular Biomarkers in Early Detection of Myocardial Fibrosis

Author(s): Shijas Shanavas, Muhammed Ajas, Abdulla Mohammed, Amina Hameedh Mahamood, Ahmad Wasim, Abdul Rahman Mohamed Elmohamed, Zahraa Khan Mohammad, Amber Ahmad, Angana Raveendran Prathapan, Muhammad Salman Arif

Myocardial fibrosis is a pathological condition characterized by the excessive accumulation of extracellular matrix components particularly collagen within cardiac tissues. This structural remodeling contributes to the increased myocardial stiffness, impaired relaxation and the progression to heart failure. Early and accurate detection of myocardial fibrosis remains challenging due to the limitations of the conventional diagnostic methods such as imaging biopsy. However, advancements in cardiovascular biomarkers offer a promising avenue for early diagnosis and disease monitoring. This review comprehensively discusses the established biomarkers including galectin-3, soluble suppression of tumorigenicity-2 (sST2) and B-type natriuretic peptide (BNP)/N-Terminal proBNP (NT-proBNP) which have demonstrated significant clinical utility in detecting and prognosticating myocardial fibrosis. Moreover, Galectin-3 is a key mediator of fibrotic processes and an independent predictor of adverse cardiac remodeling. The sST2 reflects myocardial stress and provides rapid insights into acute changes in cardia function whereas, BNP and NT-proBNP correlate with ventricular strain and offer prognostic information on disease severity and therapeutic response. Additionally, emerging biomarkers such as microRNAs (miR-21 and miR-29) and collagen-derived peptides (PICP and PIIINP) have shown promising results in enhancing diagnostic accuracy and understanding fibrotic dynamics. The integration of these biomarkers into clinical practice may facilitate early diagnosis followed by personalized treatment strategies and improved patient outcomes in myocardial fibrosis.