Left atrial function, cytokines and soluble apoptotic markers in mitral stenosis: effects of valvular replacement.
BACKGROUND
Patients with mitral stenosis (MS) and heart failure (HF) are characterized by changes in the left atrial (LA) function and activation of the apoptotic process. The purpose of the present study was the evaluation of the effect of mitral valve replacement on the LA function, on inflammatory process and apoptotic markers in patients with MS and HF.


METHODS
We studied 30 patients with MS and HF (15 in NYHA III-IV and 15 in NYHA IV) in sinus rhythm (mean age 56.2 +/- 4.6 years), and 20 age and gender matched healthy volunteers. Blood samples were obtained before and 6 months after surgical mitral valve replacement, and plasma levels of soluble Fas/APO-1 receptor (sFas), tumor necrosis factor-alpha (TNF-a) and interleukin-6 (IL-6) were measured. Echocardiographically, LA volumes were measured at mitral valve opening (Vmax), at the onset of left atrial systole (P wave of the electrocardiogram, Vp) and at the mitral valve closure (Vmin). LA contractile function was assessed by the LA active emptying fraction (ACTEF).


RESULTS
After mitral valve replacement, TNF-a, IL-6 and sFas levels, as well as the Vmax LA volume, were significantly reduced (p < 0.05). ACTEF showed a significant postoperative decrease (0.29 +/- 0.09 vs. 0.23 +/- 0.06, p < 0.01) and it was significantly correlated with sFas (r = -0.88, p = 0.001), TNF-a (r = -0.81, p = 0.001) and IL-6 (r = -0.74, p = 0.001) levels.


CONCLUSIONS
The present findings indicate that mitral valve replacement in patients with mitral valve stenosis, reduces the size of the left atrium, improves left atrial contractile function and depresses inflammatory and apoptotic process.
Trikas
Athanasios
A
Cardiology Department, University of Athens, Hippokration Hospital, Greece. atrikas@otenet.gr
Papathanasiou
Sotirios
S
Tousoulis
Dimitris
D
Tentolouris
Konstantinos
K
Vasiliadou
Karmen
K
Antoniades
Charalambos
C
Latsios
Georgios
G
Stefanadis
Christodoulos
C
D000328:Adult; D000368:Aged; D017209:Apoptosis; D015415:Biomarkers / Q000097:blood; D006325:Heart Atria / Q000503:physiopathology; D006350:Heart Valve Prosthesis; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000097:blood* / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*; D019014:fas Receptor / Q000097:blood*
D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D019014:fas Receptor