Inflammatory status in patients with rheumatic mitral stenosis: Guilty before and after balloon mitral valvuloplasty

Abstract

Aim: We studied the inflammatory status, suggested by high sensitivity C-reactive protein (hsCRP) in patients with rheumatic mitral stenosis (MS) before, immediately after, and 1-month after balloon mitral valvuloplasty (BMV). Methods and results: We studied 31 BMV candidates [35.6 ± 12.8 years, 20 (65%) females, and 9 (29%) had atrial fibrillation rhythm]. Mitral valve area (MVA) and hsCRP were measured before, immediately after BMV, and 1 month after BMV in 13 patients. In addition, hsCRP was measured in 15 controls. hsCRP was significantly higher in MS patients than control, significantly increased after BMV, and dropped 1 month after BMV to values comparable to basal but still higher than normal. hsCRP showed a trend for correlation with MVA after BMV (r = 0.384, p = 0.07), and the absolute increase in MVA (d-MVA) correlated significantly with the absolute increase in hsCRP (d-CRP) (r = 0.523, p = 0.01).21 patients had successful BMV and 10 patients had unsuccessful BMV. The increase in hsCRP post compared to pre-BMV was attenuated in patients with unsuccessful BMV, and receiver operator characteristic curve suggested that hsCRP > 3.6 before BMV and d-CRP <2.25 mg/dL can detect patients with unsuccessful BMV with good sensitivities and specificities. Conclusion: Inflammatory pathogenesis of rheumatic fever, suggested by hsCRP, seems fixed both before, and after BMV. A basal increase in hsCRP before BMV is related to BMV success and an acute increase immediately after BMV seems related to trauma of balloon dilatations.