EASIX as a predictor of 3-year mortality in aortic stenosis patients undergoing TAVR

BACKGROUND: Endothelial dysfunction plays a crucial role in the progression of aortic stenosis (AS), and the Endothelial Activation and Stress Index (EASIX) has been proposed as a biomarker for predicting mortality in various clinical settings. AIMS: Evaluating the predictive value of the EASIX for 3-year all-cause mortality in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS: We conducted a retrospective analysis of 1084 patients with severe AS, who underwent TAVR between 2013 and 2021 at the Heart Center Bonn. The EASIX was measured pre-procedural. The optimal cut-off (EASIX ≥ 1.65) was determined using the Youden index. Its association with 3-year mortality was assessed using Kaplan-Meier survival analysis and Cox regression models. The primary endpoint was 3-year all-cause mortality. RESULTS: Patients with an EASIX ≥ 1.65 had significantly higher 3-year mortality compared to those with lower EASIX (45.8% vs. 27.7%, p < 0.001). In multivariate analysis, EASIX remained an independent predictor of mortality (HR = 1.4, 95% CI: 1.1-1.8, p = 0.010). ROC analysis revealed an area under the curve (AUC) of 63.0% for the EASIX; its predictive ability was inferior to the well-established cardiac biomarkers such as NT-proBNP (AUC = 70.2%) and troponin T (AUC = 69.8%). CONCLUSION: The EASIX is a significant predictor of 3-year all-cause mortality in patients undergoing TAVR. However, its predictive performance is lower than NT-proBNP and troponin T. Integrating EASIX with traditional cardiac biomarkers may enhance risk stratification in TAVR patients and improve personalized care.