Abstract 5842: Patients with an Elevated Proportion of Small, Dense LDL and a Lower Adiponectin Blood Level are at Higher Risk of Developing Early Bioprosthetic Valve Dysfunction
Long-term durability of bioprosthetic heart valves (BPs) is limited by structural valve degeneration (SVD) leading to stenosis and/or regurgitation. We recently reported that patients having the metabolic syndrome (MetS) have higher incidence of SVD. In this study, we sought to determine the metabolic markers associated with SVD. In a cohort of 240 patients with an aortic BP and a mean follow-up of 2.5± 1.2 years, we compared the blood lipid profile and LDL size in individuals who developed echocardiographic evidence of early BP hemodynamic dysfunction versus those who did not. BP dysfunction was defined as a mean annualized transprosthetic gradient of ≥3mmHg/year and or worsening of the transprosthetic regurgitation during the echocardiographic follow-up after valve implantation. Patients developing BP dysfunction (n= 63; 26%) had higher triglyceride (TG) levels (1.53± 0.08 mmol/L vs 1.29± 0.08 mmol/L; p= 0.01), proportion of small, dense LDL (%LDL< 255Å) (46.87± 22.14 vs 40.29 ± 21.63; p= 0.08) and a tendency for having lower BP size (p= 0.05) as well as lower clearance of creatinine (p= 0.05) compared to those who had no evidence of BP dysfunction. On multivariate analysis, after adjustment for age, gender, BP size, and clearance of creatinine, the %LDL< 255Å (p=.04) were significantly associated with BP dysfunction. In addition, patients having 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 (O.R= 4.35; p= 0.01). BP dysfunction is significantly associated with the proportion of small, dense LDL. Patients having low Adiponectin levels and a high proportion of small, dense LDL are at very high risk of developing early signs of SVD. Interventions aiming at reducing the proportion of small, dense LDL particles and increasing plasma levels of Adiponectin may contribute to decrease incidence of SVD in BPs.