脂蛋白(a)与接受经导管主动脉瓣置换术患者的长期预后之间的关联。

Association between lipoprotein(a) and long-term prognosis in patients receiving transcatheter aortic valve replacement.

作者信息

Hu Xiangming, Wang Can, Feng Dejing, Li Zhe, Chen Yang, Niu Guannan, Zhou Zheng, Zhang Hongliang, Ye Yunqing, Wang Moyang, Wu Yongjian

机构信息

Department 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).

出版信息

J Clin Lipidol. 2025 May-Jun;19(3):544-553. doi: 10.1016/j.jacl.2025.03.001. Epub 2025 Mar 6.

DOI:10.1016/j.jacl.2025.03.001

PMID:40169331

Abstract

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.

摘要

背景

脂蛋白(a)[Lp(a)]已被确定为主动脉瓣狭窄（AS）的一个重要危险因素。然而，其对经导管主动脉瓣置换术（TAVR）后结局的影响仍不清楚。

目的

探讨Lp(a)水平与长期结局之间的关联及其对TAVR术后患者生物瓣膜退变的影响。

方法

连续招募接受TAVR的重度AS患者。在TAVR手术前测量Lp(a)。根据Lp(a)水平对受试者进行分组。结局指标为全因死亡率和通过多普勒超声心动图测量的可能的结构性瓣膜退变（SVD）。采用Cox回归模型和竞争风险模型探讨Lp(a)水平与结局之间的关联。

结果

在纳入的601例患者中（平均年龄：75.5±7.2岁，男性：58.7%），137例患者（22.7%）在中位随访3.9年后死亡。经过多变量调整后，Lp(a)升高（定义为≥30mg/dL）被确定为全因死亡率（风险比[HR]：1.81，95%置信区间[CI]：1.27 - 2.57，P = 0.001）和心血管死亡率（HR：2.02，95%CI：1.12 - 3.66，P = 0.020）的独立预测因素。Lp(a)升高还与可能的SVD风险增加相关（亚分布HR：3.40，95%CI：1.32 - 8.79，P = 0.012）。使用Lp(a)升高的阈值为50mg/dL仍然支持主要研究结果。