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Association between lipoprotein(a) and long-term prognosis in patients receiving transcatheter aortic valve
Xiangming Hu1, Can Wang1, Dejing Feng1
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Drs Hu, Wang, Feng, Li, Chen, Niu, Zhou, Zhang, Ye, Wang, and Wu).
Insights
Elevated Lipoprotein(a) (Lp[a]) levels predict worse outcomes and bioprosthetic valve degeneration after transcatheter aortic valve replacement (TAVR) for severe aortic stenosis.
Area of Science:
- Cardiology
- Biomedical Science
- Clinical Research
Background:
- Lipoprotein(a) (Lp[a]) is a known risk factor for aortic stenosis (AS).
- The prognostic value of Lp[a] in patients undergoing transcatheter aortic valve replacement (TAVR) for severe AS is not well-established.
Purpose of the Study:
- To assess the association between baseline Lp[a] levels and long-term clinical outcomes after TAVR.
- To investigate the impact of Lp[a] on bioprosthetic valve degeneration following TAVR.
Main Methods:
- A cohort of 601 patients with severe AS undergoing TAVR was studied.
- Pre-procedural Lp[a] levels were measured, and patients were stratified by Lp[a] concentration.
- Outcomes included all-cause mortality and structural valve degeneration (SVD) assessed via echocardiography, analyzed using Cox and competing risk models.
Main Results:
- After a median follow-up of 3.9 years, elevated Lp[a] (≥30 mg/dL) independently predicted higher all-cause mortality (HR 1.81) and cardiovascular mortality (HR 2.02).
- Higher Lp[a] levels were also significantly associated with an increased risk of possible SVD (subdistribution HR 3.40).
- Sensitivity analyses using a threshold of 50 mg/dL confirmed these findings.
Conclusions:
- Elevated baseline Lp[a] is a significant predictor of adverse clinical outcomes, including mortality and structural valve degeneration, in patients with severe AS post-TAVR.
- These findings highlight the potential role of Lp[a] as a therapeutic target in AS management.
- Further investigation is recommended to validate these results and explore clinical implications.
Background:
Lipoprotein(a) (Lp[a]) has been identified as a significant risk factor for aortic stenosis (AS). However, its impact on outcomes post-transcatheter aortic valve replacement (TAVR) remains unknown.
Objective:
To investigate the association between Lp(a) levels and long-term outcomes as well as its impact on the bioprosthetic valve degeneration in patients post-TAVR.
Methods:
Patients with severe AS who underwent TAVR were consecutively recruited. Lp(a) was measured before TAVR procedure. The subjects were divided according to levels of Lp(a). The outcomes were all-cause mortality and possible structural valve degeneration (SVD) measured by Doppler echocardiography. Cox regression models and competing risk models were used to explore the association between Lp(a) levels and outcomes.
Results:
Of the 601 included patients (mean age: 75.5 ± 7.2, male: 58.7%), 137 patients (22.7%) experienced mortality after a median follow-up of 3.9 years. After multivariable adjustment, elevated Lp(a) (defined as ≥30 mg/dL) was identified as an independent predictor of all-cause mortality (hazard ratio [HR]: 1.81, 95% CI: 1.27-2.57, P = .001) and cardiovascular mortality (HR: 2.02, 95% CI: 1.12-3.66, P = .020). Elevated Lp(a) was also associated with increased risk of possible SVD (subdistribution HR: 3.40, 95% CI: 1.32-8.79, P = .012). Using a threshold value of 50 mg/dL for elevated Lp(a) still supported the main findings.
Conclusion:
Elevated baseline Lp(a) levels are associated with poor clinical outcomes and possible SVD in patients with severe AS undergoing TAVR. Further research is warranted to confirm these findings.
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