Faculty Collaboration Database

Role of lipoprotein(a) concentrations in bioprosthetic aortic valve degeneration. Heart 2024 Jan 29;110(4):299-305

Date

08/30/2023

Pubmed ID

37643771

DOI

10.1136/heartjnl-2023-322987

Scopus ID

2-s2.0-85170692585 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

OBJECTIVES: Lipoprotein(a) (Lp(a)) is associated with an increased incidence of native aortic stenosis, which shares similar pathological mechanisms with bioprosthetic aortic valve (bAV) degeneration. However, evidence regarding the role of Lp(a) concentrations in bAV degeneration is lacking. This study aims to evaluate the association between Lp(a) concentrations and bAV degeneration.

METHODS: In this retrospective multicentre study, patients who underwent a bAV replacement between 1 January 2010 and 31 December 2020 and had a Lp(a) measurement were included. Echocardiography follow-up was performed to determine the presence of bioprosthetic valve degeneration, which was defined as an increase >10 mm Hg in mean gradient from baseline with concomitant decrease in effective orifice area and Doppler Velocity Index, or new moderate/severe prosthetic regurgitation. Levels of Lp(a) were compared between patients with and without degeneration and Cox regression analysis was performed to investigate the association between Lp(a) levels and bioprosthetic valve degeneration.

RESULTS: In total, 210 cases were included (mean age 74.1±9.4 years, 72.4% males). Median time between baseline and follow-up echocardiography was 4.4 (IQR 3.7) years. Bioprostheses degeneration was observed in 33 (15.7%) patients at follow-up. Median serum levels of Lp(a) were significantly higher in patients affected by degeneration versus non-affected cases: 50.0 (IQR 72.0) vs 15.6 (IQR 48.6) mg/dL, p=0.002. In the regression analysis, high Lp(a) levels (≥30 mg/dL) were associated with degeneration both in a univariable analysis (HR 3.6, 95% CI 1.7 to 7.6, p=0.001) and multivariable analysis adjusted by other risk factors for bioprostheses degeneration (HR 4.4, 95% CI 1.9 to 10.4, p=0.001).

CONCLUSIONS: High serum Lp(a) is associated with bAV degeneration. Prospective studies are needed to confirm these findings and to investigate whether lowering Lp(a) levels could slow bioprostheses degradation.

Author List

Farina JM, Chao CJ, Pereyra M, Roarke M, Said EF, Barry T, Alsidawi S, Sell-Dottin K, Sweeney JP, Fortuin DF, Ayoub C, Lester SJ, Oh JK, Arsanjani R, Marcotte F

Author

Ebram Farah Hana Said Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Aortic Valve
Aortic Valve Insufficiency
Aortic Valve Stenosis
Bioprosthesis
Echocardiography
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Lipoprotein(a)
Male
Middle Aged
Treatment Outcome