Lang Lisa¹, Paul Nico², Ziegler Amelie³, Weiß Max⁴, Seifert Clara⁵, Reichert Leon⁶, Bender Laura⁷, Hahn Finn⁸
ABSTRACT:
Pulmonary hypertension (PH) remains a life-threatening condition with high diagnostic and prognostic uncertainty. This review evaluates the evolving landscape of circulating biomarkers in PH, from established markers like NT-proBNP to emerging candidates such as GDF-15. We analyze: (1) the pathophysiological basis of biomarkers reflecting myocardial stress (NT-proBNP), inflammation (GDF-15, IL-6), and vascular remodeling (endothelin-1, galectin-3); (2) their performance in multicenter validation studies for risk prediction (REVEAL 2.0, COMPERA); and (3) utility in guiding treatment escalation and monitoring right ventricular adaptation. Special emphasis is placed on multi-marker panels integrating clinical, imaging, and hemodynamic data. Current limitations in biomarker standardization and future directions in extracellular vesicle-derived markers are critically discussed.