Proteoglycans as Biomarkers of Medial Degeneration in Acute Stanford Type A Aortic Dissection

Acute Stanford type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency that demands prompt and accurate diagnosis due to a high associated mortality. Although imaging remains the diagnostic gold standard, the limited accessibility and time sensitivity of this technique underscore the need for reliable serum biomarkers. D-dimer is the most widely used biomarker, offering high sensitivity; however, the limited specificity of using D-dimer has prompted a search for novel biomarkers with greater diagnostic precision. Interestingly, proteoglycans (PGs) are essential constituents of the extracellular matrix (ECM) and have emerged as promising candidates for ATAAD, as PGs are released into the circulation during medial degradation, a defining histological feature of ATAAD. Moreover, emerging evidence suggests that specific PGs exhibit favorable specificity and stability, potentially enabling distinction between ATAAD and other acute cardiovascular syndromes. Additionally, in contrast to D-dimer, which is rapidly cleared within 8 hours, certain PGs, such as aggrecan, remain stable for up to 72 hours, offering an advantage for detecting ATAAD in patients presenting beyond the early acute phase. This review summarizes the potential of aortic PGs as biomarkers of medial degeneration and circulating PGs as serum diagnostic markers of ATAAD. Future research is warranted to establish PGs as clinically reliable biomarkers, with the potential to enhance current diagnostic frameworks and support an earlier, more accurate identification of ATAAD.