title: Single lipoprotein apheresis session improves cardiac microvascular function in patients with elevated lipoprotein(a): detection by stress/rest perfusion magnetic resonance imaging.
abstract: The aim of this study was to explore the effects of a single lipoprotein apheresis session on myocardial stress/rest (S/R) perfusion in patients with elevated lipoprotein(a) (Lp(a)) and coronary artery disease using cardiac magnetic resonance imaging. Twenty patients with Lp(a) > 60 mg/dL and coronary artery disease were randomized into a control or a treatment group. Both groups underwent cardiac magnetic resonance imaging with assessment of left ventricular function, perfusion and viability, and the treatment group underwent lipoprotein apheresis immediately afterwards. Repeat magnetic resonance imaging was performed at 24 h for both groups and at 96 h for just the treatment group. The transmyocardial perfusion gradient (i.e. endo-epi ratio [EER]) was determined and a comprehensive parameter of resting and adenosine-induced stress perfusion was derived (EER-S/R). While the hematocrit remained unchanged, apheresis reduced lipoproteins and rheological parameters: Lp(a) - 55.1%, total cholesterol - 34.5%, low density lipoprotein (LDL) - 54.6%, Lp(a)-corrected LDL - 54.3%, high density lipoprotein - 17.4%, apolipoprotein B - 39.2%, plasma viscosity - 10.7%, and fibrinogen - 30.6% at 24 h (P < 0.05 for all). At 96 h these parameters, except for plasma viscosity, apolipoprotein B and Lp(a)-corrected LDL, recovered but did not reach baseline values (P < 0.05 for all). The EER-S/R at 24 h was lowered by therapy (DeltaEER-S/R 5%; P < 0.03), whereas this effect disappeared at 96 h. The ejection fraction (EF) was slightly improved at 24 h (67.07 +/- 6.28% vs. 64.89 +/- 6.39%; DeltaEF 2.2%, P < 0.05) and returned to baseline at 96 h. In the control group no corresponding changes were detected. In conclusion, cardiac magnetic resonance imaging detects subtle treatment-related changes in regional myocardial perfusion in patients with elevated Lp(a) and coronary artery disease undergoing lipoprotein apheresis.
authors.affiliation: Department of Cardiology, HELIOS-Clinic Berlin Buch Charité University Medical School, Berlin, Germany. steffen.bohl@charite.de
authors.forename: Steffen
authors.initials: S
authors.lastname: Bohl
authors.forename: Ursula
authors.initials: U
authors.lastname: Kassner
authors.forename: Rahel
authors.initials: R
authors.lastname: Eckardt
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Utz
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Mueller-Nordhorn
authors.forename: Andreas
authors.initials: A
authors.lastname: Busjahn
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Thomas
authors.forename: Hassan
authors.initials: H
authors.lastname: Abdel-Aty
authors.forename: Reinhard
authors.initials: R
authors.lastname: Klingel
authors.forename: Santica
authors.initials: S
authors.lastname: Marcovina
authors.forename: Rainer
authors.initials: R
authors.lastname: Dietz
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Steinhagen-Thiessen
authors.forename: Jeanette
authors.initials: J
authors.lastname: Schulz-Menger
authors.forename: Anja
authors.initials: A
authors.lastname: Vogt
mesh_terms: D000328:Adult; D001809:Blood Viscosity; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005500:Follow-Up Studies; D006400:Hematocrit; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008074:Lipoproteins / Q000097:blood; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010956:Plasmapheresis / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D017270:Lipoprotein(a); D008074:Lipoproteins; D005340:Fibrinogen