Use of CMR imaging to assess the effect of lipoprotein apheresis in patients with refractory angina and raised lipoprotein(a)

Background Angina which is refractory to conventional medical therapy and revascularisation with bypass surgery and/or percutaneous coronary intervention is extremely challenging to manage with limited treatment options and a pressing need to establish effective therapy. Lipoprotein(a) [Lp(a)], a genetically determined form of LDL-cholesterol, is an independent cardiovascular risk factor which is felt to increase risk by promoting thrombosis; enhancing intimal lipoprotein deposition, and by potentially affecting myocardial perfusion, microvascular function, plasma viscosity and endothelial function. Lipoprotein apheresis is currently the most effective treatment available for raised Lp(a). Increasing evidence suggests that aggressive Lp(a) reduction may improve cardiovascular outcomes, although much more prospective research is required to confirm this.