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Balloon mitral valvotomy (BMV) has emerged as the treatment of choice for severe pliable rheumatic mitral stenosis (MS). Restenosis occurs in 10– 20 % on long–term follow up. The exact mechanism for restenosis is still unknown.
To study the role of chronic inflammation as a mechanism of mitral valve restenosis post BMV.
We evaluated the serum levels of interleukin6 (IL–6) and C–reactive protein (CRP) in 60 patients who had previous successful BMV and came for clinical and echocardiographic follow up. Thirty of them had mitral valve restenosis (groupA) and the other 30 did not develop restenosis (groupB). Both groups were compared to 10 healthy individuals as controls.
There was no significant difference between groups regarding age, gender, NYHA class, rhythm and mitral regurgitation grade. IL–6 values were significantly higher in group A than group B (227.17±96.1 versus 131.1± 50.3 pg/ml, p<0.001). Moreover, CRP level was higher in group A than group B (18.3±13.8 versus 10±6 mg/dL, p=0.035). Both groups had higher levels of CRP and IL–6 than the controls. Moreover, we found that patients who did not receive long acting penicillin regularly had significantly more restenosis. However, when a multivariate stepwise logistic regression model was initiated, it was found that only IL–6>165 pg/ml and incompliance to Long acting penicillin could independently predict the occurrence of restenosis, while CRP was excluded from the model, and that IL–6 was stronger as an independent predictor than incompliance to LAP (relative odds ratio:17.49, 6.22, p<0.001, 0.012, respectively). Receiver operator characteristic curve was constructed to test the ability of IL–6 in predicting mitral valve restenosis after BMV. It was found that IL–6 value >165 pg/ml strongly predicts patients with restenosis with good sensitivity and specificity (AUC: 0.835, 95%CI: 0.734 to 0.936, sensitivity: 83%, specificity: 70%, and p<0.001).
A chronic ongoing inflammatory process, mediated partly through IL–6 and CRP could have a role in the mechanism of MV restenosis post BMV.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Valvular Heart Disease: Clinical VIII
Abstract Category: 31. Valvular Heart Disease: Clinical
Presentation Number: 1286–89
- 2013 American College of Cardiology Foundation