Impact of elevated lipoprotein(a) on epicardial coronary flow conductance and endoluminal atherosclerotic disease distribution
Article 2025 en
Authors
MR
Mick Renkens
TT
Tsung‐Ying Tsai
PR
Pruthvi C. Revaiah
Abstract
1 min read
In this PIONEER IV sub-study (NCT04923191), we investigated the effect of elevated lipoprotein(a) [Lp(a)] on epicardial coronary flow and endoluminal disease distribution. We analyzed 392 vessels from 75 propensity-matched pairs using Quantitative Flow Ratio (QFR) to assess flow limitation and the virtual QFR-Pressure Pullback Gradient Index (QFR-PPGi) to characterize disease distribution patterns (focal versus diffuse). Vessels exposed to elevated Lp(a) exhibited significantly higher rates of epicardial flow limitation (QFR ≤ 0.80) than controls (31 % vs. 19 %, absolute risk difference 12 %; 95 % CI: 2.7 %-21 %, p = 0.011). The median difference in baseline QFR between matched vessels was -0.045 (p = 0.005), while the mean difference in QFR-PPGi was -0.028 (p = 0.013). These findings demonstrate that elevated Lp(a) levels are associated with both greater epicardial flow limitation and a more diffuse pattern of coronary artery disease.
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