PT  - JOURNAL ARTICLE
AU  - Mohamed Jalloul Nsaibia
AU  - Ablajan Mahmut
AU  - Haifa Mahjoub
AU  - Abdellaziz Dahou
AU  - Rihab Bouchareb
AU  - Marie-Chloé Boulanger
AU  - Jean-Pierre Després
AU  - Yohan Bossé
AU  - Benoît J Arsenault
AU  - Eric Larose
AU  - Philippe Pibarot
AU  - Patrick Mathieu
TI  - Association between plasma lipoprotein levels and bioprosthetic valve structural degeneration
AID  - 10.1136/heartjnl-2016-309541
DP  - 2016 Dec 01
TA  - Heart
PG  - 1915--1921
VI  - 102
IP  - 23
4099  - http://heart.bmj.com/content/102/23/1915.short
4100  - http://heart.bmj.com/content/102/23/1915.full
SO  - Heart2016 Dec 01; 102
AB  - Introduction Structural valve degeneration (SVD) leads to the failure of aortic valve bioprostheses. It is suspected that lipid-derived factors could play a role in SVD. We hypothesised that oxidised low-density lipoprotein (OxLDL), OxLDL/LDL, OxLDL/high-density lipoprotein (OxLDL/HDL) and proprotein convertase subtilisin/kexin 9 (PCSK9) may be associated with SVD.Methods We included 199 patients who underwent an aortic valve replacement with a bioprosthesis and had an echocardiography follow-up to evaluate the function of the prosthesis. SVD was defined as an increase in mean transprosthetic gradient (≥10 mm Hg) or a worsening of transprosthetic regurgitation (≥1/3) during the follow-up.Results After a mean follow-up of 8±3.5 years, 41(21%) patients developed SVD. The univariate predictors of SVD were LDL (p=0.03), apolipoprotein B (p=0.01), OxLDL (p=0.02), OxLDL/HDL (p=0.009) and LDL associated with small, dense particles (LDL-C<255Å) (p=0.02). In a model adjusted for covariates, only OxLDL/HDL (OR 1.49, 95%CI 1.08 to 2.07 per 10 units, p=0.01) remained associated with SVD. There was a significant interaction between OxLDL/HDL and PCSK9 on SVD (p=0.05). After adjustment, compared with patients with low OxLDL/HDL (median, <25.4) and low PCSK9 (median, <298 ng/mL) (referent), patients with both an elevated OxLDL/HDL ratio and PCSK9 had a higher risk of SVD (OR 2.93, 95% CI 1.02 to 9.29, p=0.04).Conclusions OxLDL/HDL ratio is independently associated with SVD.