Elevated Proportion of Small, Dense Low-Density Lipoprotein Particles and Lower Adiponectin Blood Levels Predict Early Structural Valve Degeneration of Bioprostheses

Abstract

Objectives: Long-term durability of bioprosthetic heart valves (BPs) are limited by structural valve degeneration (SVD) leading to stenosis and/or regurgitation. In this study, we sought to determine the metabolic markers associated with SVD. Methods: In a cohort of 220 patients with an aortic BP (mean follow-up of 2.5 ± 1.2 years), we compared the metabolic and blood lipid profile including the levels of adiponectin and the proportion of small, dense low-density lipoprotein (LDL) particles (%LDL_<_255Å) in individuals developing echocardiographic evidence of early BP hemodynamic dysfunction with subjects having no features of BP dysfunction. Results: Patients developing BP dysfunction (n = 69; 31.3%) had a tendency of higher triglyceride levels. Moreover, patients with BP dysfunction had an increased proportion of %LDL_<_255Å. In multivariate linear regression analysis, after adjustment for age, gender, BP size and hypertension, the %LDL_<_255Å (p = 0.04) was significantly associated with BP dysfunction. In addition, patients with an elevated level of %LDL_<_255Å along with a decreased plasma adiponectin level were at a very high risk of developing early BP hemodynamic dysfunction (OR = 2.54, p = 0.04). Conclusion: BP dysfunction is significantly associated with an increased proportion of small, dense LDL.

Association between plasma lipoprotein levels and bioprosthetic valve structural degeneration

“…Also, a high proportion of small, dense LDL has been associated with SVD 14. We also reported that a high apoB/apoA ratio was independently associated with SVD 12.…”

Calcification and Oxidative Modifications Are Associated With Progressive Bioprosthetic Heart Valve Dysfunction

“…In the present study, 7 of 16 patients with CABG also had DM (Table ). The presence of oxidized low‐density lipoprotein in BHV leaflets with SVD associated hyperlipidemia with SVD, and related lipoprotein abnormalities as comorbidities with SVD leading to BHV reoperation have been observed by others . This may be of importance concerning our observation of increased SVD in CABG patients.…”

Is Aortic Bioprosthesis Degeneration Influenced by Metabolic Factors?

“…In the study by Shetty et al [29] published in a recent issue of Cardiology , associations were demonstrated between metabolic markers and structural degeneration of bioprostheses in the aortic position. In a population of 220 patients followed for a mean of 2.5 years after valve surgery at a single center in Canada, relatively high (>43.2%) levels of small dense LDL particles were associated with the presence of echocardiographic signs of degeneration of the new bioprosthesis, including increased gradient across the new valve or increased regurgitation when concomitantly low levels of adiponectin (≤1.81 mmol/l) were present, increasing the risk of structural valve degeneration more than 2-fold (odds ratio 2.54, p = 0.04), predominantly for the regurgitation type of valve dysfunction [29].…”

“…In a population of 220 patients followed for a mean of 2.5 years after valve surgery at a single center in Canada, relatively high (>43.2%) levels of small dense LDL particles were associated with the presence of echocardiographic signs of degeneration of the new bioprosthesis, including increased gradient across the new valve or increased regurgitation when concomitantly low levels of adiponectin (≤1.81 mmol/l) were present, increasing the risk of structural valve degeneration more than 2-fold (odds ratio 2.54, p = 0.04), predominantly for the regurgitation type of valve dysfunction [29]. These findings thus are consistent with previously published data demonstrating that atherosclerotic risk factors and metabolic syndrome predispose to the development of both native aortic stenosis and structural bioprosthesis degeneration, indicating that some common pathogenic mechanisms probably exist between the development of aortic stenosis and bioprosthesis dysfunction.…”

“…One cautionary note is necessary, however: the etiology of bioprosthesis degeneration appears to be more diverse and complex than for native valve disease. Thus, to relate the findings of Shetty et al [29] to clinical effects, further studies are needed.…”