ApoB/ApoA-I Ratio Is Associated With Increased Risk of Bioprosthetic Valve Degeneration

作者：Mahjoub Haifa; Mathieu Patrick; Senechal Mario; Larose Eric; Dumesnil Jean; Despres Jean Pierre; Pibarot Philippe^*

来源：Journal of the American College of Cardiology, 2013, 61(7): 752-761.

DOI：10.1016/j.jacc.2012.11.033

• ApoB/ApoA-I ratio
• Doppler echocardiography
• heart valve prosthesis

Objectives This study sought to identify the clinical and metabolic determinants of bioprosthetic valve degeneration. %26lt;br%26gt;Background Structural valve degeneration (SVD) is the major cause of bioprosthetic valve failure. Recent retrospective studies have reported an association between atherosclerotic risk factors and development of SVD. %26lt;br%26gt;Methods A total of 203 consecutive patients with aortic bioprosthetic valves were recruited. Doppler echocardiography and multidetector computed tomography (CT) examinations were performed for assessment of bioprosthesis calcification and abdominal adiposity. A cardiometabolic risk profile was also obtained. SVD was defined as an increase in mean transprosthetic gradient of %26gt;= 10 mm Hg and/ora worsening of transprosthetic regurgitation %26gt;= 1/3 class between 1-year post-operative echo and last follow-up echo (mean follow-up time was 8 +/- 3 years). %26lt;br%26gt;Results Forty-two patients (20%) were identified as developing SVD. Patients with SVD had significantly higher plasma total-cholesterol (4.6 +/- 1.1 mmol/l vs. 4.1 +/- 0.9 mmol/l, p = 0.05), low-density lipoprotein-cholesterol (2.5 +/- 1.0 mmol/l vs. 2.2 +/- 0.7 mmol/l, p = 0.02), and apolipoprotein B (ApoB) levels (0.71 +/- 0.22 g/l vs. 0.64 +/- 0.17 g/l, p = 0.02) and higher ApoB/ApoA-I ratios (0.48 +/- 0.17 vs. 0.41 +/- 0.11, p = 0.004) than those with no SVD. Multivariate analysis revealed that increased ApoB/ApoA-I ratio (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.10 to 1.82 per 0.1 increment; p = 0.007) and the use of bisphosphonates (OR: 3.57, 95% CI: 1.14 to 10.80 p = 0.02) were the strongest independent predictors of SVD. %26lt;br%26gt;Conclusions This is the first study to report a strong association between increased ApoB/ApoA-I ratio and the risk of developing SVD among patients with aortic bioprosthetic valves. Further studies are needed to determine if an elevated ApoB/ApoA-I ratio, which reflects the balance of proatherogenic and antiatherogenic lipoproteins, is a risk marker or a risk factor for SVD.

• 出版日期2013-2-19