Associations of aortic valve area and calcification with diastolic heart function and high lipoprotein(a) levels in a population study

Objective. To assess diastolic cardiac function depending on aortic valve area (AVA) and relationship between calcification and Lp(a) in adult urban population. Material and methods. Analysis was carried out in a sample of participants in the population-based cross-sectional study “Know your heart” (Arkhangelsk, 2015—2017). Age of patients was 35-69 years (n=2372). Survey, laboratory and echocardiography data were used. Results were adjusted for gender and age. Results. We identified 3 groups depending on AVA (n=2105): group 1 — AVA>1.5 cm2, (reference group), 94.5% (n=1989); group 2 — AVA 1.0—1.5 cm2, 4.7% (n=98); group 3 — AVA<1.0 cm2 (severe AS), 0.9% (n=18). Mean transvalvular pressure gradient did not correspond to severity of AS in the 3rd group, and ejection fraction (EF) was >50%. In the same group, atrial fibrillation, cancer and abdominal obesity were more common. E lateral <10 cm/sec was associated with AVA. The odds ratio was 1.97 (95% CI 1.22—3.19, p=0.006) for the 2nd group and 3.88 (95% CI 1.02—14.73, p=0.047) for the 3rd group. The index E/e (LV filling pressure) negatively correlated with AVA (β=—0.12; p <0.001). Prevalence of aortic valve calcification was 6.9% (8.8% among men and 5.6% among women). Lp(a) was independently associated with aortic valve calcification: OR=1.99 (95% CI 1.21—3.26, p=0.006) for 50—100 mg/dL, 4.64 (95% CI 2.45—8.79, p <0.001) for >100 mg/dL compared to the reference category of Lp(a) <50 mg/dL. Conclusion. In population of Arkhangelsk residents aged 35—69 years, diastolic cardiac dysfunction increases as AVA decreases. Lp(a) is independently associated with aortic valve calcification. The risk of aortic valve calcification increases with Lp(a) concentration >50 mg/dL.