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Published on: February 4, 2021
Association Between Plasma Lipoprotein Levels and Aortic Valve Calcification Among Patients with Aortic Valve
Tingting Tao1, Junnan Zheng1, Yu Han1
1Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
Insights
Elevated total cholesterol is a risk factor for calcific aortic valve disease (CAVD), alongside age and mean transaortic gradient. Patients with aortic valve calcification (AVC) experienced worse one-year outcomes.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Calcific aortic valve disease (CAVD) is a common valvular heart condition.
- The link between dyslipidemia and CAVD is not fully understood.
Purpose of the Study:
- To investigate the association between plasma lipoprotein levels and aortic valve calcification (AVC) in patients undergoing aortic valve replacement.
- To identify risk factors and outcomes associated with AVC.
Main Methods:
- Retrospective analysis of 449 patients who underwent aortic valve replacement.
- Categorization into aortic valve calcification (AVC) and non-calcification groups.
- Logistic regression analysis of preoperative and one-year postoperative data, including lipoprotein levels and echocardiographic parameters.
Main Results:
- AVC patients had higher rates of coronary heart disease, peripheral vascular disease, and heart failure preoperatively.
- Significantly higher total cholesterol and very low-density cholesterol levels were observed in the AVC group.
- Age, total cholesterol, and mean transaortic gradient were identified as AVC risk factors, while a larger aortic valve area was protective. One-year mortality and perivalvular leakage were higher in the AVC group.
Conclusions:
- Elevated total cholesterol, along with age and mean transaortic gradient, are significant risk factors for AVC.
- AVC is associated with poorer short-term outcomes, including increased mortality and complications.
Objective:
Calcific aortic valve disease (CAVD) is a prevalent type of valvular heart disease, its association with dyslipidemia remains controversial.
Methods:
Of 449 CAVD patients who underwent aortic valve replacement, 228 formed the aortic valve calcification (AVC) group, and 221 were the non-calcification group. We retrospectively reviewed the preoperative and one-year postoperative plasma lipoprotein levels of both and performed a logistic regression to evaluate the factors associated with AVC.
Results:
Preoperatively, AVC patients had significantly higher coronary heart disease (43.0% vs 24.9%, p<0.001), peripheral vascular disease (41.7% vs 26.2%, p<0.001), and heart failure rates (63.6% vs 47.1%, p<0.001), and a higher level of total cholesterol (4.1±0.9 vs 3.9±0.8 mmol/L, p=0.032) and very low-density cholesterol (0.6 (0.4-0.7) vs 0.5 (0.3-0.7) mmol/L, p=0.054). Echocardiography revealed a significant difference of aortic stenosis in both AVC and non-AVC groups (p<0.05), and also identified aortic regurgitation (AR) with a significant difference between these two groups (p=0.003). The peak transaortic jet velocity, peak transaortic gradient, and mean transaortic gradient were significantly higher in the calcification group (all p<0.001), but the aortic valve area (0.7 (0.5-1.0) vs 4 (0.9-4.5) cm2; p<0.001) was smaller. Age (OR=1.023), total cholesterol (OR=1.272), and mean transaortic gradient (OR=1.182) were AVC risk factors. A larger aortic valve area (OR=0.010) were protective factors. The one-year mortality and perivalvular leakage rates were significantly higher in the calcification group.
Conclusion:
Total cholesterol was significantly higher in AVC patients and may be an AVC risk factor along with age and mean transaortic gradient. AVC patients had a relatively poorer outcome within one year.
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