Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02087-y

Can an accelerated degeneration of bioprosthetic valves be expected in patients with high levels of Lp(a)?

F. Menges1, K.-P. Mellwig1, V. Rudolph1, C. Piper1

1Klinik für Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;

Background Elevated Lp(a) levels are known to be associated with degenerative aortic stenosis and the need for surgical or interventional valve replacement. Therefore, it can be expected that degeneration of bioprosthetic valves is accelerated in patients with high levels of Lp(a) as well. Objectives The aim of our study was to analyse whether patients with high Lp(a) levels are prone to a premature degeneration of their bioprosthetic valves requiring early reoperation or transcatheter valve-in-valve-replacement. Methods Retrospectively, we reviewed the Lp(a) concentration of 110 patients admitted to our cardiovascular centre to undergo treatment of their degenerated bioprosthetic valves. Of these, 52 patients had elevated Lp(a) levels above 30 mg/dl. We correlated levels of Lp(a) with durability of bioprosthetic valves and analysed whether the results were biased by other cardiovascular risk factors such as the corrected concentration of LDL, high blood pressure, diabetes or obesity. Furthermore, different groups (G) according to their level of Lp(a) (G0: ≤ 30 mg/dl, G1: ≤ 60 mg/dl, G2: ≤ 90 mg/dl, G3: > 90 mg/dl) were compared regarding mean bioprosthetic valve durability. Results There was no strong correlation between levels of Lp(a) and bioprosthetic valve durability (r = -0.166, p = 0.082). However, when comparing the mean durability in different groups of Lp(a) levels (G0 – G3), a reciprocal association could be determined (G0: 111 months, G1: 114 months, G2: 110 months, G3: 86 months). Nonetheless, the differences between the groups were not significant (p = 0.331). Therefore, we additionally compared G0 and G3 which revealed a better but not yet statistically significant result (p = 0.061). In addition, neither high concentrations of LDL nor hypertension or a high BMI had a significant influence on the association of Lp(a) levels and bioprosthetic valve durability (pLDL = 0.976, paHT = 0.491, pBMI = 0.681). However, diabetes mellitus turned out to markedly affect the above association (pdiabetes = 0.036). Conclusions Our study indicates that high levels of Lp(a) may cause an accelerated degeneration of bioprosthetic valves, especially in diabetic patients. This association should be analysed further in a larger cohort of patients to improve the statistical quality. If the tendency detected in the present study is confirmed, Lp(a)-lowering therapeutical options such as antisense therapy should be discussed for patients with bioprosthetic valves and elevated Lp(a) levels.

https://dgk.org/kongress_programme/ht2022/aP711.html