Salivary Biomarkers for Diagnosis and Therapy Monitoring in Patients with Heart Failure. A Systematic Review

Aidonis Rammos, Aris Bechlioulis, Petros Kalogeras, Evanthia E. Tripoliti, Yorgos Goletsis, Anna Kalivi, Effrosyni Blathra, Pietro Salvo, M. Giovanna Trivella, Tommaso Lomonaco, Roger Fuoco, Francesca Bellagambi, Chris J. Watson, Abdelhamid Errachid, Dimitrios I. Fotiadis, Lampros K. Michalis, Katerina K. Naka*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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The aim of this study was to perform a systematic review on the potential value of saliva biomarkers in the diagnosis, management and prognosis of heart failure (HF). The correlation between saliva and plasma values of these biomarkers was also studied. PubMed was searched to collect relevant literature, i.e., case-control, cross-sectional studies that either compared the values of salivary biomarkers among healthy subjects and HF patients, or investigated their role in risk stratification and prognosis in HF patients. No randomized control trials were included. The search ended on 31st of December 2020. A total of 15 studies met the inclusion criteria. 18 salivary biomarkers were analyzed and the levels of all biomarkers studied were found to be higher in HF patients compared to controls, except for amylase, sodium, and chloride that had smaller saliva concentrations in HF patients. Natriuretic peptides are the most commonly used plasma biomarkers in the management of HF. Their saliva levels show promising results, although the correlation of saliva to plasma values is weakened in higher plasma values. In most of the publications, differences in biomarker levels between HF patients and controls were found to be statistically significant. Due to the small number of patients included, larger studies need to be conducted in order to facilitate the use of saliva biomarkers in clinical practice.

Original languageEnglish
Article number824
Number of pages14
Issue number5
Publication statusPublished - 02 May 2021

Bibliographical note

Funding Information:
Funding: This work is supported by the KardiaTool project ( that has received funding from the European Union’s Horizon 2020 research and innovation program under the grant agreement No. 768686. This article reflects only the authors’ view. The Commission is not responsible for any use that may be made of the information it contains.

Funding Information:
Author Contributions: Conceptualization, A.R., A.B., L.K.M. and K.K.N.; Methodology, A.R., A.B., and K.K.N.; Validation, E.E.T., Y.G., P.S., M.G.T., T.L., R.F., F.B., C.J.W., A.E., and D.I.F.; Investigation, A.R., P.K., A.K., E.B.; Resources, L.K.M., and K.K.N.; Data Curation, E.E.T., Y.G.; Writing—Original Draft Preparation, A.R., A.B.; Writing—Review & Editing, A.R., D.I.F., and K.K.N.; Visualization, A.R. and K.K.N.; Supervision, D.I.F., L.K.M., and K.K.N.; Project Administration, L.K.M., and K.K.N.; Funding Acquisition, D.I.F., and K.K.N., as part of the consortium of the KardiaTool project, funded by the European Union’s Horizon 2020 program. All authors have read and agreed to the published version of the manuscript.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Copyright 2021 Elsevier B.V., All rights reserved.


  • Biomarkers
  • Diagnosis
  • Heart failure
  • Saliva
  • Therapy monitoring

ASJC Scopus subject areas

  • Clinical Biochemistry


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