FATİH UZUN, İsmail BAYIK, İbrahim Faruk AKTÜRK, Mohammad Toib AMERİ, Mehmet ERTÜRK, DERYA ÖZTÜRK, Ali Kemal KALKAN, Ahmet Arif YALÇIN, Özgür SÜRGİT, Aydın Rodi TOSU, Ali BİRAND

Can percutaneous mitral balloon valvuloplasty reduce ongoing inflammation in patients with rheumatic mitral stenosis?

Amaç: Romatizmal kalp kapağı hastalığı patofizyolojisin- de kronik sistemik inflamatuar süreç önemli bir rol oynar. Biz bu çalışmada perkütan translüminal mitral balon val- vüloplastinin (PTMV) romatizmal mitral darlığı olan hasta- larda kronik sistemik inflamatuar yanıt üzerinde etkisinin olup olmadığını araştırdık. Yöntemler: Biz bu çalışmada sistemik inflamatuar yanı- tın derecesini değerlendirmek için kolay ulaşılan ve ucuz bir belirteç olan nötrofil lenfosit oranını (NLR) kullandık. Çalışmaya ciddi mitral darlığı olup başarılı PTMV yapılan toplam 41 hasta dahil edildi. Tüm hastaların NLRsi PTMV işlemi öncesinde ve sonrasında değerlendirildi. Bulgular: PTMV öncesinde ve sonrasında ortalama len- fosit sayısı, 2,1±0,6 x103 /µL; 1,9±0,6 x103 / µL (p=0,01), ve ortalama lökosit sayısı 4,8±1,4 x103 /µL; 4,4±1,3 x103 / µL (p=0.069) bulundu. Romatizmal mitral darlığı olan has- talarda PTMV sonrası NLR değerlerinde anlamlı düşüş saptandı. (2,7±1,0 ve 2,2± ,8, p = 0.001). Korelasyon ana- lizinde mitral kapak alanı ve NLR arasında anlamlı negatif korelasyon (p= 0,004- r=0,440), ve sol atrial çap ile NLR arasında anlamlı pozitif korelasyon saptandı. (p=0,028 r=0,344). Sonuç: Bu çalışma romatizmal mitral darlığı olan has- talarda PTMV sonrası NLR değerlerinde anlamlı düşüş göstermiştir. Bu PTMV sonrası inflamasyonun azalması anlamına gelebilir. Bu sonuçların desteklenmesi için daha büyük çalışmalara ihtiyaç vardır

Perkütan mitral balon valvüloplasti romatizmal mitral darlığı olan hastalardaki inflamasyonu azaltabilir mi?

Objective: In the pathophysiology of rheumatic heart valve disease, chronic systemic inflammatory process plays an important role. In this study, we aimed to inves- tigate whether the percutaneous transluminal mitral bal- loon valvuloplasty (PTMV) has any effect on the chronic systemic inflammatory response in patients with rheumat- ic mitral stenosis (RMS). Methods: In this study, we used neutrophil to lymphocyte ratio (NLR), which is a simply available and inexpensive biomarker of systemic inflammatory response, to evalu- ate the level of inflammation. A total of 41 consecutive patients with severe RMS undergoing successful PTMV were included in the study. Laboratory assessments of all patients by the measuring of NLR before and after the PTMV procedure were performed. Results: Before and after the PTMV, the mean lympho- cyte counts were found 2.1±0.6 x103 /µL and 1.9±0.6 x103 / µL (p=0.01), and the mean leukocyte counts were 4.8±1.4 x103 /µL and 4.4±1.3 x103 /µL (p=0.069) respec- tively. NLR values were determined as 2.7 ± 1.0 and 2.2 ± 0.8. After the PTMV, there was a significant decrease in NLR in patients with rheumatic mitral stenosis patients (p=0.001). In the correlation analysis, there was signifi- cant negative correlation between the mitral valve area and NLR (p= 0.004- r=0.440), and there was significant positive correlation between left atrial diameter and NLR (p=0.028 r=0.344). Conclusion: This study showed significant decrease in NLR after PTMV in patients with RMS, which means re- duced inflammation after PTMV. Larger studies are need- ed to confirm the results.

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1. Otto CM, Bonow RO. Valvular heart disease. In Libby P, Bonow RO, Mann DL, Zipes DP. Braunwalds heart dis- ease, A textbook of cardiovascular medicine. 8th edn. Phil- adelphia, USA, Saunders Elsevier, 2008:1646-1647. 2. Yıldız A, Kaya H, Ertaş F, et al. Short-term follow-up results of percutaneous mitral balloon valvuloplasty: A single-cen- ter experience. Dicle Med J 2014;41:695-699. 3. Nishimura RA, Otto CM, Bonow RO, et al. American Col- lege of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a re- port of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:e57-185. 4. Golbasi Z, Ucar O, Keles T, et al. Increased levels of high sensitive C-reactive protein in patients with chronic rheu- matic valve disease: evidence of ongoing inflammation. Eur J Heart Fail 2002;4:593-595. 5. Yetkin E, Erbay AR, Ileri M, et al. Levels of circulating adhe- sion molecules in rheumatic mitral stenosis. Am J Cardiol 2001;88:1209-1211. 6. Templeton AJ, McNamara MG, eruga B, et al. Prognos- tic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 2014; 106: dju124. 7. Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardio- vasc Ther 2013;11:55-59. 8. Polat N, Yildiz A, Yuksel M, et al. Association of Neutro- philLymphocyte Ratio With the Presence and Severity of Rheumatic Mitral Valve Stenosis, Clinical and Applied Thrombosis/Hemostasis 2014;20:793-798. 9. Akboğa MK, Akyel A, Şahinarslan A, et al. Neutrophil-to- lymphocyte ratio is increased in patients with rheumatic mitral valve stenosis? Anatol J Cardiol 2015;15:380-384. 10. Rifaie O, Omar AM, Abdel-Rahman MA, et al. Does a chronic inflammatory state have a role in the development of mitral restenosis after balloon mitral valvuloplasty? Int J Cardiol 2014;172: e417-418. 11. Chen MC, Chang HW, Wu CJ, et al. Percutaneous translumi- nal mitral valvuloplasty reduces circulating soluble CD40 ligand in rheumatic mitral stenosis. Chest 2005;128:36-41. 12. Quinones MA, Otto CM, Stoddard M, et al. Recommen- dations for quantification of Doppler echocardiography: a report from the Doppler quantification task force of the nomenclature and standards committee of the Ameri- can society of echocardiography. J Am Soc Echocardiogr 2002;15:167-184. 13. Horstkotte D, Niehues R, Strauer BE. Pathomorphological aspects, aetiology and natural history of acquired mitral valve stenosis. Eur Heart J 1991;12; suppl B:55-60. 14. Atalar E, Ozturk E, Ozer N, et al. Plasma soluble osteopon- tin concentrations are increased in patients with rheumatic mitral stenosis and associated with the severity of mitral valve calcium. Am J Cardiol 2006;98:817-820. 15. Krasuski RA, Bush A, et al. C-reactive protein elevation independently influences the procedural success of percu- taneous balloon mitral valve commissurotomy. Am Heart J 2003;146:1099-1104. 16. Akboğa MK, Abacı A, Canpolat U, et al. Association of red blood cell distribution width with presence and severity of rheumatic mitral valve stenosis. Turk Kardiyol Dern Ars 2015;43:227-233. 17. Chiu-Braga YY, Hayashi SY, Schafranski M, et al. Further evidence of inflammation in chronic rheumatic valve dis- ease (CRVD): high levels of advanced oxidation protein products (AOPP) and high sensitive C-reactive protein (hs- CRP). Int J Cardiol 2006;109:275-276. 18. Banerjee T, Mukherjee S, Ghosh S, et al. Clinical signifi- cance of markers of collagen metabolism in rheumatic mi- tral valve disease. PLoS One 2014;9:e90527. 19. Pulimamidi VK, Murugesan V, Rajappa M, et al. Increased levels of markers of oxidative stress and inflammation in patients with rheumatic mitral stenosis predispose to left atrial thrombus formation. J Clin Diagn Res 2013;7:2445- 2448. 20. Cagli KE, Aras D, Topaloglu S, et al. S. Plasma levels of tu- mor necrosis factor-alpha and its receptors in patients with mitral stenosis and sinus rhythm undergoing percutaneous balloon valvuloplasty. Heart Vessels 2010;25:131-137. 21. Mukherjee S, Jagadeeshaprasad MG, Banerjee T, et al. Proteomic analysis of human plasma in chronic rheumatic mitral stenosis reveals proteins involved in the complement and coagulation cascade. Clin Proteomics 2014;11:35. 22. Ozturk D, Erturk M, Celik O, et al. The role of the neu- trophil/lymphocyte ratio in patients with rheumatic mitral stenosis as an indicator of spontaneous echocardiographic contrast. Kardiol Pol 2014;72:969-976. 23. Chopra P, Gulwani H. Pathology and pathogenesis of rheu- matic heart disease. Indian J Pathol Microbiol 2007;50:685- 697. 24. Ostovan M, Aslani A, Abounajmi S, et al. Mitral valve re- stenosis after percutaneous transmitral valvuloplasty, role of continuous inflammation. J Cardiovasc Thorac Res 2014;6:191-195