Time course of C-reactive protein, tumour necrosis factor-alpha and monocyte chemoattractant protein-1 following the surgical treatment of patients with aortic valve stenosis.
BACKGROUND
Patients with aortic valve stenosis show elevated levels of inflammatory markers in peripheral blood. The aim of this study was to investigate the time course of changes in these markers and to look for sex-related changes in their biological behaviour following aortic valve replacement.


METHODS
We studied 52 patients (32 men, 20 women) who underwent aortic valve replacement and had no concomitant coronary artery disease. Men and women did not differ significantly with respect to age, body surface area, or body mass index. Levels of high sensitivity C-reactive protein (hsCRP), tumour necrosis factor-alpha (TNF-alpha) and monocyte chemoattractant protein-1 (MCP-1) were measured from venous blood samples taken before, and 10 days, 3 months and 6 months after aortic valve replacement.


RESULTS
Baseline hsCRP levels were 5.34 +/- 5.71 mg/dl and 7.64 +/- 7.46 mg/dl for men and women, respectively. Levels increased significantly at 10 d (49.11 +/- 32.15 and 51.63 +/- 34.3 mg/dl, p < 0.001), then reduced at 3 m (5.85 +/- 5.04 and 8.49 +/- 7.69 mg/dl, p < 0.001) and 6 m (3.41 +/- 0.83 and 7.84 +/- 7.32 mg/dl, p < 0.001). Women had higher levels than men at 6 m (p = 0.027). Levels of TNF-alpha reduced progressively, from 212.4 +/- 119.5 and 255.7 +/- 171.3 pg/ml at baseline, to 121.6 +/- 47.7 and 150.0 +/- 33.5 pg/ml at 10 d, 134.7 +/- 25.3 and 138.6 +/- 30.9 at 3 m, and 48.7 +/- 8.8 and 44.9 +/- 10.5 pg/ml at 6 m (p < 0.001). MCP-1 levels also reduced progressively, from 157 +/- 64.8 and 145.6 +/- 13.4 pg/ml at baseline, to 128.6 +/- 18.8 and 122.7 +/- 10.3 pg/ml at 10 d, 49.0 +/- 12.4 and 56.6 +/- 11.5 pg/ml at 3 m, and 29.1 +/- 6.4 and 30.6 +/- 7.3 pg/ml at 6 m (p < 0.001). The time course of the changes in these indexes was identical for men and women, except that 6 m hsCRP levels were significantly higher in women.


CONCLUSIONS
After aortic valve replacement, hsCRP levels show an early increase followed by a decrease, whereas both TNF-alpha and MCP-1 are reduced progressively. The time course curve is identical in men and women, except that hsCRP levels are higher in women than in men 6 months after aortic valve replacement.
Kastellanos
Stylianos S
SS
Cardiac Surgery Department, Hippokration Hospital, Athens, Greece. castel@otenet.gr
Toumpoulis
Ioannis K
IK
Aggeli
Constadina
C
Zezas
Stefanos
S
Chlapoutakis
Emmanouil
E
Kastellanos
Stamatis
S
Stefanadis
Christodoulos I
CI
D000368:Aged; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000601:surgery*; D002097:C-Reactive Protein / Q000032:analysis*; D018932:Chemokine CCL2 / Q000097:blood*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012737:Sex Factors; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
D018932:Chemokine CCL2; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein