This secretory protein was originally used to diagnose ovarian cancer30 and has been shown to be associated with higher rates of rehospitalization and mortality in the HF population, as well as other cardiovascular diseases but has not yet been examined in the valvular heart disease population.19, 20, 21,31 To our knowledge, this is the first study to examine and demonstrate the association between HE4 serum levels with adverse clinical events in patients undergoing TAVI and assess its association with myocardial fibrosis. This evidence concerns the gene WFDC2 and hydrops fetalis.