Prognostic value of Endothelial Activation and Stress Index (EASIX) in moderate-to-severe aortic stenosis patients: the ARISTOTLE cohort study

Endothelial dysfunction is a pivotal pathophysiological change in aortic stenosis (AS). The Endothelial Activation and Stress Index (EASIX) is a validated marker associated with endothelial dysfunction, with predictive value in prognosis of several diseases. However, the prognostic value of EASIX in AS patients requires further investigation. The study cohort comprised 817 moderate-to-severe AS patients. The optimal EASIX cut-off value was obtained by the Youden index, and patients were subsequently stratified accordingly. The correlation between EASIX and mortality was assessed by Kaplan–Meier curves, Cox regression and restricted cubic spline analyses. The incremental predictive value of EASIX was evaluated. Kaplan-Meier curves revealed higher all-cause mortality ( p for log-rank < 0.039) in high EASIX group. In multivariate Cox analysis, the high EASIX group exhibited a 1.66-fold greater all-cause mortality risk compared to the low EASIX group (HR 1.66, 95% CI 1.25–2.20, p = 0.001) and per log2 increase in EASIX was corresponding to a 24% elevated all-cause mortality risk (HR 1.24, 95% CI 1.07–1.43, p = 0.004). A significant linear correlation was observed between log2(EASIX) and all-cause mortality risk in the restricted cubic spline analysis ( p for nonlinear = 0.068). EASIX conferred additional prognostic information beyond the baseline risk model for predicting all-cause mortality. For patients with moderate to severe AS, increased EASIX is linked to an adverse prognosis. This study was registered in the Chinese Clinical Trials Registry. Registration Number: NCT06069232. Prognostic value of Endothelial Activation and Stress Index (EASIX) in moderate to severe aortic stenosis. The figure was created with BioGDP.com [1].