Background There is evidence that elevated plasma Lipoprotein a [Lp(a)] plays an essential role as an independent, likely causal and heritable risk factor for cardiovascular diseases (CVD) and calcific aortic valve stenosis (CAVS), especially amongst patients with mild to moderate CAVS. However, the importance of Lp(a) as a risk factor for aortic valve calcification (AVC) in patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear.

Objectives The aim of this study is to determine the influence of Lp(a) on the amount of AVC amongst patients undergoing TAVI.

Methods A total of 513 patients who underwent TAVI in the period from August 2019 to June 2020 were included in this prospective study. Because of missing data or already existing aortic valve protheses, the data of 454 patients was left for the purpose of statistical analysis. Plasma Lp(a) levels were measured in mg/dl by immunoassay and the amount of AVC in mm³ was assessed by 3Mensio Structural Heart™ software. The Lp(a) threshold was determined as 60 mg/dl.

Results The study group consists of 243 men (53.5 %) and 211 women (46.5 %) at an average age of 81 ± 6 years. 102 (22.5 %) patients have plasma Lp(a) levels ≥ 60 mg/dl and 353 (77.5 %) < 60 mg/dl. The median amount of AVC is 894.5 mm³ [interquartile range (IQR) 812 mm³ [570.75 mm³, 1382.75 mm³]]. Mann-Whitney-U-tests show no significant differences between patients with elevated and below-threshold Lp(a) levels regarding the median quantity of AVC (p = 0.831 for total group; p = 0.731 for men; p = 0.696 for women), but a significant difference when divided by gender [p < 0.001; median AVC 1101 mm³ (IQR 779 mm³ [774 mm³, 1553 mm³]) for men; 645 mm³ (IQR 628 mm³ [420 mm³, 1048 mm³]) for women]. On the contrary, the Lp(a) levels in both gender groups are comparable [p = 0.351; median Lp(a) 17 mg/dl (IQR 39 mg/dl [6 mg/dl, 45 mg/dl]) for men; 16 mg/dl (IQR 56 mg/dl [7 mg/dl, 63 mg/dl]) for women]. Furthermore, Spearman´s Rho indicates no significant correlation between Lp(a) levels and the calcification volume (p = 0.434). Age, 30-day mortality and in-hospital mortality or functional aortic valve measurements [e. g. aortic valve gradients (AVG) or aortic valve area (AVA)] were not different in patients with low or high Lp(a) levels.