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. 2022 Jan;108(1):61-66.
doi: 10.1136/heartjnl-2021-319804. Epub 2021 Sep 30.

Lipoprotein(a) has no major impact on calcification activity in patients with mild to moderate aortic valve stenosis

Yannick Kaiser  1 , Nick S Nurmohamed  1   2 , Jeffrey Kroon  3 , Hein J Verberne  4 , Evangelos Tzolos  5 , Marc R Dweck  5 , Aernout G Somsen  6 , Benoit J Arsenault  7 , Erik S G Stroes  1 , Kang H Zheng  1 , S Matthijs Boekholdt  8
Affiliations

Lipoprotein(a) has no major impact on calcification activity in patients with mild to moderate aortic valve stenosis

Yannick Kaiser et al. Heart. 2022 Jan.

Abstract

Objective: To assess whether patients with aortic valve stenosis (AS) with elevated lipoprotein(a) (Lp(a)) are characterised by increased valvular calcification activity compared with those with low Lp(a).

Methods: We performed 18F-sodium fluoride (18F-NaF) positron emission tomography/CT in patients with mild to moderate AS (peak aortic jet velocity between 2 and 4 m/s) and high versus low Lp(a) (>50 mg/dL vs <50 mg/dL, respectively). Subjects were matched according to age, gender, peak aortic jet velocity and valve morphology. We used a target to background ratio with the most diseased segment approach to compare 18F-NaF uptake.

Results: 52 individuals (26 matched pairs) were included in the analysis. The mean age was 66.4±5.5 years, 44 (84.6%) were men, and the mean aortic valve velocity was 2.80±0.49 m/s. The median Lp(a) was 79 (64-117) mg/dL and 7 (5-11) mg/dL in the high and low Lp(a) groups, respectively. Systolic blood pressure and low-density-lipoprotein cholesterol (corrected for Lp(a)) were significantly higher in the low Lp(a) group (141±12 mm Hg vs 128±12 mm Hg, 2.5±1.1 mmol/L vs 1.9±0.8 mmol/L). We found no difference in valvular 18F-NaF uptake between the high and low Lp(a) groups (3.02±1.26 vs 3.05±0.96, p=0.902). Linear regression analysis showed valvular calcium score to be the only significant determinant of valvular 18F-NaF uptake (β=0.63; 95% CI 0.38 to 0.88 per 1000 Agatston unit increase, p<0.001). Lp(a) was not associated with 18F-NaF uptake (β=0.17; 95% CI -0.44 to 0.88, p=0.305 for the high Lp(a) group).

Conclusion: Among patients with mild to moderate AS, calcification activity is predominantly determined by established calcium burden. The results do not support our hypothesis that Lp(a) is associated with valvular 18F-NaF uptake.

Keywords: aortic valve stenosis; positron emission tomography computed tomography.

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Conflict of interest statement

Competing interests: ESGS has received research grants/support to his institution from Amgen, Sanofi, Resverlogix and Athera, and has served as a consultant for Amgen, Sanofi, Esperion, Novartis and Ionis Pharmaceuticals. All other authors report no conflict of interest.

Figures

Figure 1
Figure 1
Aortic valve calcification activity stratified by lipoprotein(a) (Lp(a)) group. Depicted is the calcification activity of the aortic valve, measured as maximum target to background ratio. This was calculated by dividing the valvular maximum standardised uptake by the blood pool mean standardised uptake value. There was no significant difference in calcification activity between high and low Lp(a) groups (3.02±1.26 vs 3.05±0.96, p=0.902).
Figure 2
Figure 2
Lp(a) has no major impact on calcification activity in patients with mild to moderate aortic valve stenosis. In this case–control study consisting of matched patients with aortic stenosis with high versus low Lp(a), we observed comparable calcification activity in both groups. Aortic valve calcium score was the only variable associated with 18F-NaF uptake in linear regression analysis (β=0.60 per 1000 Agatston unit increase, 95% CI 0.39 to 0.81). Lp(a), lipoprotein(a); NaF PET/CT, sodium fluoride positron emission tomography/CT.
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