High sensitivity CRP levels predict atrial tachyarrhythmias in rheumatic mitral stenosis.
BACKGROUND
The different levels of inflammation in rheumatic mitral stenosis determine its clinical consequences. Atrial fibrillation is frequently encountered in mitral stenosis, though the independent role of chronic inflammation in determining atrial tachyarrhythmia occurrence in rheumatic heart disease has not been demonstrated previously.


METHODS
Measurements of C-reactive protein (CRP) with a high sensitivity assay to detect chronic inflammation were performed in a homogenous group of 50 patients with rheumatic mitral stenosis, who were in sinus rhythm. Patients were questioned to exclude confounders of CRP elevation. The patients underwent a twenty-four-hour ambulatory ECG monitoring to check for asymptomatic atrial tachyarrhythmias and were in addition classified according to the presence of atrial tachyarrhythmias.


RESULTS
Forty-four percent of patients showed a total of 100 episodes of atrial tachyarrhythmias where 63% of these episodes were paroxysmal atrial fibrillation. The CRP values in patients with tachyarrhythmias were significantly higher than in patients who remained in sinus rhythm (4.2 +/- 0.55 mg/L vs 1.99 +/- 0.36 mg/L, P < 0.001). A logistic regression analysis revealed only CRP levels and previous history of mitral valvuloplasty significantly determined tachyarrhythmia occurrence where age, left atrial volumes, mitral gradients had no statistically significant effect.


CONCLUSIONS
Our data implicated that nearly half of the mitral stenosis patients who are in sinus rhythm develop asymptomatic tachyarrhythmias and the higher levels of CRP in these patients show the significant effect of persistent inflammation on arrhythmia occurrence.
Ucer
Ekrem
E
Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Department of Cardiology, Istanbul, Turkey. ekremucer@yahoo.com
Gungor
Baris
B
Erdinler
Izzet Celal
IC
Akyol
Ahmet
A
Alper
Ahmet Taha
AT
Eksik
Abdurrahman
A
Cakmak
Nazmiye
N
Gurkan
Kadir
K
Ulufer
Tanju
T
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002908:Chronic Disease; D015716:Electrocardiography, Ambulatory / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000209:etiology / Q000503:physiopathology*; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012216:Rheumatic Diseases / Q000150:complications*; D012680:Sensitivity and Specificity
D015415:Biomarkers; D002097:C-Reactive Protein