Human Epididymis Protein 4 in Transcatheter Aortic Valve Implantation: Diagnostic and Prognostic Value

Giuliani, C; Zanuttini, A; Nuche, J; Farjat Pasos, JI; Bernard, J; Lionel, T; Jacob, S; Abu-Alhayja'a, R; Beaudoin, J; Côté, N; DeLarochellière, R; Paradis, JM; Clavel, MA; Arsenault, BJ; Rodés-Cabau, J; Pibarot, P; Hecht, S

doi:10.1016/j.jacadv.2025.101722

Valvular & structural heart disease

Human Epididymis Protein 4 in Transcatheter Aortic Valve Implantation: Diagnostic and Prognostic Value

JACC AdvPublished 25 Apr 2025prospective study

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Authors' conclusion

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.

Study context

Population: Patients who underwent transcatheter aortic valve implantation (TAVI)patients who underwent TAVI, cardiac magnetic resonance subgroup of 43 patients · T1 mapping on cardiac magnetic resonance subgroup 43
Participants: 362 patients

Exposure: Patients with higher HE4 serum levels vs lower serum levels
Outcome: Rehospitalization for heart failure, all-cause mortality and composite endpoint (all patients)
Follow-up: Median 2.5 (IQR: 1.9-3.2) years

Main finding

As reported in the abstract

Rehospitalized for heart failure

34 of 362

9.4%

Died

99 of 362

27.3%

Composite endpoint of rehospitalization for heart failure or all-cause mortality

113 of 362

31.2%

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with higher HE4 serum levels ←→ Higher risk with higher HE4 serum levels →	Adjusted HR (95% CI)	P value
All-cause mortality · following TAVIIncreased risk with higher HE4 · multivariable Cox regression	0.20.5125	3.26 (2.04–5.20)	P < 0.001
Composite endpoint of rehospitalization for heart failure or all-cause mortality · following TAVIIncreased risk with higher HE4 · multivariable Cox regression	0.20.5125	2.48 (1.64–3.74)	P < 0.001
	0.20.5125Adjusted hazard ratio (log scale)

Median native T1 mapping values (diffuse myocardial fibrosis) · 1 to 3 months following the procedure

Patients with higher HE4 serum levels had higher median native T1 mapping values; values as printed: 1,278 [95% CI: 1,239-1,280] ms vs 1,352 [95% CI: 1,303-1,376] ms, P < 0.001

Subgroup of 43 patients

Original publication

Human Epididymis Protein 4 in Transcatheter Aortic Valve Implantation: Diagnostic and Prognostic Value. JACC Adv. Published 25 April 2025. doi:10.1016/j.jacadv.2025.101722

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