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(Circulation. 2006;114:I-512 – I-517.)
© 2006 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Metabolic Syndrome Is Associated With Faster Degeneration of Bioprosthetic Valves

Martin Briand, MS; Philippe Pibarot, DVM, PhD; Jean-Pierre Després, PhD; Pierre Voisine, MD; Jean G. Dumesnil, MD; François Dagenais, MD; Patrick Mathieu, MD

From the Laval Hospital Research Center/Québec Heart Institute (M.B., P.P., J.-P.D., P.V., J.G.D., F.D., P.M.), Department of Medicine (M.B., P.P., J.G.D.), Department of Social and Preventive Medicine (J.-P.D.), and Department of Surgery (P.V., F.D., P.M.), Laval University, Québec, Canada.

Correspondence to Philippe Pibarot, Laval Hospital Research Center, 2725 Chemin Sainte-Foy, Sainte-Foy, Quebec, Canada, G1V-4G5. E-mail philippe.pibarot{at}med.ulaval.ca

Background— Several studies have reported similarities between calcification of the native aortic valve and atherosclerosis. Recent studies also suggested that hypercholesterolemia may be a risk factor for calcific degeneration of bioprosthetic valves. The metabolic syndrome (MS) is associated with a higher risk of vascular atherosclerosis. We thus hypothesized that the atherogenic features of MS could accelerate bioprosthetic valve degeneration.

Methods and Results— We included 217 patients who underwent aortic valve replacement with a bioprosthetic valve in the study. Of these patients, 71 patients (33%) had MS defined according to the modified criteria proposed by the National Cholesterol Education Program Adult Treatment Panel III. The annualized increase in mean transprosthetic gradient and the worsening of transprosthetic regurgitation measured by Doppler echocardiography were used to assess the deterioration of valve hemodynamic function. Patients with MS had higher progression of gradient (+4±5 mm Hg/year versus +2±2 mm Hg/year, P<0.001), higher proportion of 1/3 degree worsening of regurgitation (25% versus 12%, P=0.02), and higher proportion of valve function deterioration defined as regurgitation worsening and/or 3 mm Hg/year increase in gradient (41% versus 25%, P=0.02) when compared with patients without MS. On multivariate analysis, MS was an independent predictor of gradient progression (P=0.01), regurgitation worsening (P=0.02), and valve function deterioration (P=0.02). The other independent predictors were diabetes, renal insufficiency, and higher mean gradient at baseline.

Conclusions— This is the first study to report that the MS is independently associated with faster bioprosthetic valve degeneration. This study could pave the way for the development of a new medical therapy able to significantly reduce the structural valve deterioration of bioprostheses.

Key Words: heart valve prosthesis • metabolic syndrome • Doppler echocardiography

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