Abstract 15247: Usefulness of Circulating Human Epididymis Protein 4 to Predict Outcomes After Transcatheter Aortic Valve Implantation
Bibliographic record
Abstract
Introduction: 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. Hypothesis: was to examine the prognostic value of HE4 in patients undergoing transcatheter aortic valve implantation (TAVI). Methods: 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 rehospitalization for heart failure (HF), and 2) composite endpoints of rehospitalization for HF and all-cause mortality. Results: Patients with higher HE4 plasma levels were older (81.2 ± 7.8 years vs 78 ± 8.3 years, p<0.001) and presented with more global 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, 98 (27.3%) patients died and composite endpoint 113 (31%). 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 was associated with a markedly higher risk of all-cause mortality (HR [95%CI]: 3.32 [1.96-5.60], p<0.001). They also had higher 4-year rates of HF rehospitalization (13 vs 6%; log-rank p-value=0.015) and of the composite of HF rehospitalization and all-cause mortality (45 vs 18%; adjusted HR [95%CI]: 2.38 [1.50 - 3.78], p<0.001). Conclusion: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".