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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. Human Epididymis Protein 4 in Transcatheter Aortic Valve Implantation: Diagnostic and Prognostic Value. JACC. ADVANCES 2025; 4:101722. [PMID: 40286377 PMCID: PMC12103096 DOI: 10.1016/j.jacadv.2025.101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 02/12/2025] [Accepted: 03/06/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND The utility of the human epididymis protein 4 (HE4) in patients undergoing transcatheter aortic valve implantation (TAVI) has not been established yet. OBJECTIVES The present study aimed at examining the prognostic value of HE4 in patients undergoing TAVI. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Carlos Giuliani
- 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
| | - Antonela Zanuttini
- 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
| | - Jorge Nuche
- 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
| | - Julio I Farjat Pasos
- 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
| | - Jérémy Bernard
- 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
| | - Tastet Lionel
- 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
| | - Simon Jacob
- 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
| | - Rami Abu-Alhayja'a
- 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
| | - Jonathan Beaudoin
- 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
| | - Nancy Côté
- 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
| | - Robert DeLarochellière
- 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
| | - Jean-Michel Paradis
- 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
| | - Marie-Annick Clavel
- 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
| | - Benoit J Arsenault
- 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
| | - Josep Rodés-Cabau
- 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
| | - Philippe Pibarot
- 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
| | - Sébastien Hecht
- 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.
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Coisne A, Lancellotti P, Côté N, Ternacle J, Hecht S, Grapsa J, Hahn RT, Clavel MA, Vannan MA, Lindman B, Garbi M, Oury C, Donal E, Scotti A, Ludwig S, Postolache A, Myers P, Dweck MR, Pibarot P. Blood biomarkers in left-sided valvular heart disease. Eur Heart J 2025:ehaf232. [PMID: 40259754 DOI: 10.1093/eurheartj/ehaf232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 01/11/2025] [Accepted: 03/20/2025] [Indexed: 04/23/2025] Open
Abstract
Valvular heart disease (VHD) is a common condition that poses several challenges from the standpoints of diagnosis and therapeutic management. While several studies have explored the role of blood biomarkers in assessing the severity and risk of progression of VHD, as well as in evaluating related cardiac damage and predicting the occurrence of adverse events, blood biomarkers are generally not considered criteria to trigger valve intervention in the latest European and American guidelines for VHD management. This review article provides an up-to-date overview of the utility of blood biomarkers to (i) assess the presence, severity, and progression of left-sided VHD; (ii) establish the presence and extent of cardiovascular damage; (iii) predict clinical outcomes before and after valve interventions; and (iv) identify patients at risk for early structural valve deterioration, valve thrombosis, and paravalvular leak.
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Affiliation(s)
- Augustin Coisne
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Bd Pr Jules Leclercq, 59000 Lille, France
- Cardiovascular Research Foundation, New York City, NY 10019, USA
| | - Patrizio Lancellotti
- GIGA Metabolism and Cardiovascular Biology, University of Liège, Liège, Belgium
- Department of Cardiology, Heart Valve Clinic, University Hospital CHU Sart Tilman, Liège B-4000, Belgium
| | - Nancy Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Université Laval, Quebec City, Quebec, Canada
| | - Julien Ternacle
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionnelle Structurelle, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Sébastien Hecht
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Université Laval, Quebec City, Quebec, Canada
| | - Julia Grapsa
- Guy's and St Thomas' NHS Trust Hospitals, London, UK
| | - Rebecca T Hahn
- Columbia University Medical Center/NY Presbyterian Hospital, New York City, NY 10032, USA
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Université Laval, Quebec City, Quebec, Canada
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | | | - Madalina Garbi
- Royal Papworth Hospital, Cambridge University Health Partners, Cambridge Biomedical Campus, Cambridge, UK
| | - Cécile Oury
- GIGA Metabolism and Cardiovascular Biology, University of Liège, Liège, Belgium
| | - Erwan Donal
- Cardiology Department, CHU de Rennes, Rennes, France
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College, Bronx, NY 10467, USA
| | - Sebastian Ludwig
- Cardiovascular Research Foundation, New York City, NY 10019, USA
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Marc R Dweck
- BHF Centre of Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Université Laval, Quebec City, Quebec, Canada
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Brankovic M, Sharma A. Transcatheter Aortic Valve Implantation and Replacement: The Latest Advances and Prospects. J Clin Med 2025; 14:1844. [PMID: 40142651 PMCID: PMC11942769 DOI: 10.3390/jcm14061844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 03/06/2025] [Accepted: 03/06/2025] [Indexed: 03/28/2025] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, particularly in patients at high risk of adverse events for traditional open-heart surgery. Since the early 2000s, TAVR has evolved rapidly with advancements in device technology, procedural techniques, and patient selection criteria. Over the past 20 years, this catheter-based procedure has significantly improved patient survival and quality of life, demonstrating both the safety and efficacy of TAVR, even in patients at low surgical risk. This paper reviews the latest advances in valve design and strategies for treating aortic stenosis. It explores the challenges with long-term outcomes given the younger age of patients undergoing TAVR and the prospects of emerging technologies to improve long-term outcomes.
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Affiliation(s)
- Milos Brankovic
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Abhishek Sharma
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
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