Percutaneous Transluminal Mitral Valvuloplasty Reduces Circulating Soluble CD40 Ligand in Rheumatic Mitral Stenosis

Relation between left atrial strain and exercise tolerance in patients with mild mitral stenosis: An insight from 2D speckle-tracking echocardiography

BACKGROUND

Mild mitral stenosis (MS) is a progressive disease but unfortunately, its clinical course is still unclearly studied. We aimed to study the left atrial (LA) deformation in such patients and how it is related to exercise intolerance.

METHODS

Seventy-five patients with mitral valve area of 1.81 ± 0.13 cm² and 40 healthy control subjects were enrolled. All participants had sinus rhythm, and they underwent conventional echocardiography and LA strain analysis with speckle-tracking study. The following parameters were obtained: left atrial reservoir strain (LAS-s), LA conduit strain (LAS-e), and LA contraction strain (LAS-a). All participants underwent symptoms limited stress ECG using modified Bruce protocol.

RESULTS

Comparing with control subjects, patients with mild MS had significant lower LAS-s value (P < .01) and LAS-e (<0.03). Patients with exercise intolerance (METs < 8) had lower LAS-s (P < .001), LAS-e (P < .01), and LAS-a (P < .05) values compared to those with METs ≥ 8. We found that METs was significantly related to LAS-s (P < .001), brain natriuretic peptide (P < .001), and Δ TAPSE (P < .03). Multivariate analysis showed that LAS-s was an independent predictor of reduced exercise capacity. With ROC analysis, LAS-s ≤ 26.5% was the optimal value for prediction of exercise intolerance in patients with mild MS.

CONCLUSION

A significant percentage of patients with mild mitral stenosis had exercise intolerance. We found that LAS-s was significantly associated with exercise capacity in patients with mild MS. Hence, we thought that LA deformation could be of great value in the follow-up of patients with mild MS.

Changes in platelet, coagulation, and fibrinolytic activities in mitral stenosis after percutaneous mitral valvotomy: role of hemodynamic changes and systemic inflammation

Markers of platelet activity (P-selectin), fibrinolysis (d-dimer), thrombin activity (prothrombin fragments 1, 2 [PF1,2] and thrombin-antithrombin III complex [TAT]), and inflammation (interleukin 1β [IL-1β]) were measured in 65 patients with mitral stenosis (MS) before and 2 weeks after percutaneous mitral valvotomy (PMV) and in 23 controls. All markers were significantly higher than the control and significantly decreased after PMV. P-selectin change correlated with the changes in left atrial diameter (LAD), pulmonary artery systolic pressure (PASP), and IL-1β. d-Dimer change had similar correlations, LAD, PASP, and IL-1β. The PF1,2 change correlated with the change in IL-1β. The TAT change correlated with the changes in LAD. The IL-1β change correlated with the changes in PASP. In conclusion, MS is associated with heightened inflammatory, platelet, thrombin, and fibrinolytic activities that decrease after PMV. Altered hemodynamics and reduced inflammatory activity might have a possible role in these changes.

Platelet Activation in Coronary Artery Disease

BACKGROUND

Platelet activation and aggregation play a key role in coronary artery disease, with antiplatelet therapies leading to improved clinical outcomes. Limited data exist as to whether peripheral venous blood measurements of platelet physical indexes (eg, platelet count, volume, and granularity) and soluble markers of platelet activation (eg, P-selectin [sP-sel] and CD40 ligand [CD40L]) reflect the local (intracardiac) coronary environment. Furthermore, how percutaneous coronary interventions (PCIs) affect levels of peripheral/cardiac platelet indexes is unclear.

METHODS

Blood samples were sequentially acquired from the coronary os, aortic root, coronary sinus, and the femoral vein, and where relevant, pre-PCI and post-PCI. Eighty-seven patients undergoing coronary angiography were recruited (mean [+/-SD] age, 59.8+/-10.8 years; 54 men [62%]), of whom 36 proceeded to PCI. Platelet physical indexes and plasma sP-sel and CD40L levels were measured (by enzyme-linked immunosorbent assay).

RESULTS

At baseline, no intracardiac vs peripheral differences were noted in sP sel levels, while CD40L levels were elevated in the aorta compared to the coronary sinus and femoral venous. The mean platelet count (MPC) was similar at all four sites, but within the coronary sinus blood, mean platelet volume (MPV) was significantly lower and mean platelet granularity (MPG) was higher when compared to arterial levels. Though aortic and femoral levels of sP-sel were raised following PCI, transcardiac gradients of plasma sP-sel levels were unaffected. PCI was associated with lower CD40L, MPC, and MPV levels but with a higher MPG level in all sampling sites.

CONCLUSIONS

sP-sel levels measured peripherally reflect the cardiac environment, unlike CD40L, MPC, MPV, and MPG. PCI leads to further platelet activation (raised sP-sel) despite aggressive antiplatelet therapy.