Prognostic value of human epididymis protein 4 following transcatheter aortic valve implantation

Plasma level of Human Epididymis protein 4 (HE4) has been shown to be associated with an increased risk of cardiac events in dilated and ischemic cardiomyopathies. The objective of this study was to examine the prognostic value of HE4 in patients undergoing transcatheter aortic valve implantation (TAVI). Three hundred sixty-two patients (mean age: 79.6 ± 8.2 years; 57.3% men) undergoing TAVI for severe aortic stenosis were prospectively enrolled in this study. The cohort was divided into two groups according to the median value of pre-intervention HE4 plasma levels (115 pmol/l). The primary endpoints were: 1) all-cause mortality and 2) rehospitalization for heart failure (HF). Patients with higher HE4 plasma levels were older (81.2 ± 7.8 years vs 78 ± 8.3 years, p< 0.001) and had global more comorbidities (i.e.: diabetes mellitus, chronic heart failure, renal failure, Euroscore II, STS score and left ventricular ejection fraction; all p< 0.05). During a median follow-up of 2.5 (1.9-3.2) years, 34 (9.4%) patients were rehospitalized for HF, and 98 (27.3%) patients died. The 4-year survival rate was significantly lower in patients with higher HE4 plasma levels (44% vs. 71%; p< 0.001). In the multivariable Cox proportional hazard regression model adjusted for diabetes mellitus, chronic heart failure, coronary artery disease, chronic obstructive pulmonary disease, atrial fibrillation, Society of Thoracic Surgeons score, and left ventricular ejection fraction, patients with HE4 >115 pmol/l had a higher risk of all-cause mortality (HR [95%CI]: 3.32 [1.96-5.60], p< 0.001). They also had a 4-year higher rate of rehospitalization for HF (13 vs. 6%; log-rank p-value = 0.015; adjusted HR [95%CI]: 2.1 [1.05-4.47], p=0.01). Elevated HE4 plasma levels are independently associated with a higher risk of all-cause mortality and HF rehospitalization following TAVI. This novel biomarker may be useful to enhance risk stratification and therapeutic decision-making.View Large Image Figure ViewerDownload Hi-res image Download (PPT)