Giuliani Carlos, Zanuttini Antonela, Nuche Jorge, Farjat Pasos Julio I, Bernard Jérémy, Lionel Tastet, Jacob Simon, Abu-Alhayja'a Rami, Beaudoin Jonathan, Côté Nancy, DeLarochellière Robert, Paradis Jean-Michel, Clavel Marie-Annick, Arsenault Benoit J, Rodés-Cabau Josep, Pibarot Philippe, Hecht Sébastien
Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada.
Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada.
JACC Adv. 2025 Apr 23;4(5):101722. doi: 10.1016/j.jacadv.2025.101722.
The utility of the human epididymis protein 4 (HE4) in patients undergoing transcatheter aortic valve implantation (TAVI) has not been established yet.
The present study aimed at examining the prognostic value of HE4 in patients undergoing TAVI.
In this prospective study, the prognostic value of HE4 to predict adverse clinical events was evaluated in 362 patients who underwent TAVI. The association between HE4 and diffuse myocardial fibrosis was also assessed using T1 mapping on cardiac magnetic resonance in a subgroup of 43 patients.
During a median follow-up of 2.5 (IQR: 1.9-3.2) years, 34/362 (9.4%) patients were rehospitalized for heart failure, 99/362 (27.3%) died, and 113/362 (31.2%) met the composite endpoint of rehospitalization for heart failure or all-cause mortality. In multivariable Cox regression analyses, patients with higher HE4 serum levels (ie, HE4 ≥130 pmol/L) vs lower serum levels (ie, HE4 <130 pmol/L) had increased risk of all-cause mortality (adjusted HR: 3.26 [95% CI: 2.04-5.20], P < 0.001), and of the composite endpoint (adjusted HR: 2.48 [95% CI: 1.64-3.74], P < 0.001) following TAVI, respectively. Patients with higher HE4 serum levels had higher median native T1 mapping values (1,278 [95% CI: 1,239-1,280] ms vs 1,352 [95% CI: 1,303-1,376] ms, P < 0.001) at 1 to 3 months following the procedure.
Elevated HE4 serum levels are associated with diffuse myocardial fibrosis and increased risk of adverse clinical events following TAVI. This promising blood biomarker may be helpful to enhance risk stratification in patients undergoing TAVI.
人附睾蛋白4（HE4）在经导管主动脉瓣植入术（TAVI）患者中的应用尚未确立。
本研究旨在探讨HE4在TAVI患者中的预后价值。
在这项前瞻性研究中，对362例行TAVI的患者评估了HE4预测不良临床事件的预后价值。还在43例患者的亚组中使用心脏磁共振T1成像评估了HE4与弥漫性心肌纤维化之间的关联。
在中位随访2.5（四分位间距：1.9 - 3.2）年期间，362例患者中有34例（9.4%）因心力衰竭再次住院，99例（27.3%）死亡，113例（31.2%）达到心力衰竭再次住院或全因死亡的复合终点。在多变量Cox回归分析中，与血清HE4水平较低（即HE4 <130 pmol/L）的患者相比，血清HE4水平较高（即HE4≥130 pmol/L）的患者全因死亡风险增加（校正风险比：3.26 [95%置信区间：2.04 - 5.20]，P <0.001），TAVI后复合终点风险增加（校正风险比：2.48 [95%置信区间：1.64 - 3.74]，P <0.001）。术后1至3个月，血清HE水平较高的患者中位固有T1成像值更高（分别为1278 [95%置信区间：1239 - 1280]毫秒和1352 [95%置信区间：1303 - 1376]毫秒，P <0.001）。
血清HE4水平升高与弥漫性心肌纤维化以及TAVI后不良临床事件风险增加相关。这种有前景的血液生物标志物可能有助于加强TAVI患者的风险分层。
