Author + information
- Yasin Türker1,
- Ismail Ekinozu1,
- Yusuf Aslantas1,
- Yasemin Turker2,
- Mehmet Akkaya3 and
- Melih Engin Erkan4
Both high sensitivity CRP (hs-CRP) and uric acid (UA) levels are known to be increased in heart failure patients and are associated with poorer functional capacity and adverse outcome. The role of these markers in patients with mitral regurgitation (MR) is less clear. The aim of this study was to evaluate the relationship between hs-CRP, UA and organic MR. We also evaluated whether hs-CRP, UA levels are interrelated with symptoms of MR, the severity of MR, LV remodeling and outcome at 12 month follow-up.
A total of 200 consecutive patients (87 men [43.5%]; mean age 61.6±12.5 years) with isolated and organic moderate or severe MR were included in the study. Patients were categorized according to the New York Heart Association (NYHA) functional class. We assessed and graded the severity of MR using a multiparametric approach.
Baseline demographic, clinical characteristics and laboratory parameters of patients with MR are listed and compared between asymptomatic and symptomatic patients in Table 1. High-sensitivity CRP was significantly elevated among symptomatic MR patients when compared with asymptomatic patients (5.9±6.8 vs. 2.56±1.9 mg/l; p =0.004). Median hs-CRP levels were increased significantly with increase in NYHA class (NYHA class I=1.50 mg/l [0.90-3.50], NYHA class II=2.73 mg/l [2.59-6.57], NYHA class III=5.20 mg/l [3.30-9.30], NYHA class IV=4.07 mg/l [4.03-7.92], p<0.001; Figure 1). Similar correlation was also found with MR severity and median hs-CRP levels found to be increased significantly with higher degrees of MR (moderate=2.62 mg/l [1.70-2.95], moderate to severe=5.20 mg/l [3.30-5.6], severe=5.53 mg/l [4.50-9.30], p=0.002; Figure 2). Uric acid levels were significantly elevated among symptomatic MR patients than asymptomatic ones (6.5±2.4 vs. 4.5±1.6 mg/dl; p<0.001). Mean UA levels increased significantly with NYHA class: 4.46±1.58 mg/dl for NYHA I, 5.91±1.69 mg/dl for NYHA II, 6.31±2.16 mg/dl for NYHA III and 8.86±3.17 mg/dl for patients in NYHA IV (p<0.001; Figure 3). Mean UA levels were also increased significantly with increase in severity of MR (moderate=5.62±1.9 mg/dl, moderate to severe=5.56±1.2 mg/dl, severe=7.38±3.4 mg/dl, p<0.001; Figure 4). There was a significant correlation between UA level and LVEDD (r=0.40; p<0.001, Figure 5), LVESD (r=0.297; p=0.001) and LVEF (r=0.195, p=0.036), whereas hs-CRP was not correlated with those parameters. In multivariate Cox proportional hazards analysis LVEF, NYHA class and UA levels were the only independent predictors of death (Table 2).
Uric acid and hs-CRP levels can help to identify patients with asymptomatic moderate/severe mitral regurgitation from the symptomatic ones. Uric acid levels may be useful to assess the extent of LV remodeling and in the optimal timing of mitral valve surgery in certain subset of patients.