Elevated Proportion of Small, Dense Low-Density Lipoprotein Particles and Lower Adiponectin Blood Levels Predict Early Structural Valve Degeneration of Bioprostheses

OBJECTIVES: Long-term durability of bioprosthetic heart valves (BPs) are limited by structural valve degeneration (SVD) leading to stenosis and/or regurgitation. In this study, we sought to determine the metabolic markers associated with SVD. METHODS: In a cohort of 220 patients with an aortic BP (mean follow-up of 2.5 ± 1.2 years), we compared the metabolic and blood lipid profile including the levels of adiponectin and the proportion of small, dense low-density lipoprotein (LDL) particles (%LDL(<)(255Å)) in individuals developing echocardiographic evidence of early BP hemodynamic dysfunction with subjects having no features of BP dysfunction. RESULTS: Patients developing BP dysfunction (n = 69; 31.3%) had a tendency of higher triglyceride levels. Moreover, patients with BP dysfunction had an increased proportion of %LDL(<)(255Å). In multivariate linear regression analysis, after adjustment for age, gender, BP size and hypertension, the %LDL(<)(255Å) (p = 0.04) was significantly associated with BP dysfunction. In addition, patients with an elevated level of %LDL(<)(255Å) along with a decreased plasma adiponectin level were at a very high risk of developing early BP hemodynamic dysfunction (OR = 2.54, p = 0.04). CONCLUSION: BP dysfunction is significantly associated with an increased proportion of small, dense LDL.