The Effects Of Percutaneous Balloon Mitral Valvuloplasty On Cardiac Inlfammation And Electrophysiology And Its Cardiological Risks Prediction

ObjectiveTo study the effects of percutaneous balloon mitral valvuloplasty (PBMV) oncardiac inflammation and cardioelectrophysiology in patients with rheumatic mitralstenosis, and try to reveal the risk factors which influence the efficacy of PBMV andassess the value of varieties of factors in prediction of cardiological risk byprospective study.MethodsTotal of126patients with rheumatic mitral stenosis were enrolled and receivedPBMV. All of them were given medical treatment by using diuretics, β-blockers, etc.3months before operation to control edema and heart rate, but they would receiveoperaton ahead of schedule if heart function couldn’t be improved. Left atrialpressure (LAP) and pulmonary artery pressure (PAP) were measured by catheterbefore and after dilatetion in the presedure of operating.Besides of serum hypersensitive C-reactive protein concentration (Hs-CRP) andplasma B-type Natriuretic Peptide (BNP) concentration, QRS complex duration, Pwave terminal force in lead V1(PtfV1), P-wave dispersion (PWd) and QT dispersion(QTd) by multi-conductive electorphysiological analyzer, mitral valve area (MVA),left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDd), leftventricular ejection fraction (LVEF), stroke volume (SV) and cardiac output (CO) byechocardiograph, were also recorded respectively before and after PBMV. Complica-tions were observed routinely.120successful operation patients were enrolled into follow-up. Cardiovascularevents were recorded at follow-up, including re-hospitalization for valve disease,heart function by New York Heart Association (NYHA) class, malignant arrhethmia,heart chambers dilating, re-currence of edema even if diuretics used, new atrialfibrillation and cardiac death.The paired t-test was used to compare pre-and post-operation. Independent t-test was used between the two groups. The chi-square test was used to evaluate endpoint event rate. Linear regression and correlation analysis was used to assess therelationship among plasma BNP concentration, serum Hs-CRP concentration, andhemodynamic parameters. Logistic regression analysis was used to analyze thecorrelation of the incidence of cardiovascular events with all kinds of risk factors.Receiver operating characteristic (ROC) curve analysis was used to assess theoccurrence of future atrial fibrillation.ResultsOne hundred and twenty (95.3%) of126patients underwent PBMV successfully,while6failed to complications, including2with cardiac perforation,3with severemitral regurgitation,1with cerebral embolism. There was no case with acute heartfailure, and severe arrhythmia.After percutaneous balloon mitral valvuloplasty, MVA significantly increased (p<0.05). LAD, E peak velocity, PAP, and LAP significantly decreased (p <0.05); heartfunction improved (p <0.05); BNP, PtfV1, PWd, QTd, and HR decreased at differentdegrees (p <0.05); QRS complex duration, LVEF, cardiac output, stroke volume hadno significant difference; plasma BNP concentration was decreased in post-operation(P <0.01) and a negative correlation with MVA (r=0.428, p <0.05); Serum hs-CRPconcentration increased markedly after operation (p <0.01),and a positive correlationwith MVA (r=0.326, p <0.05).Compared with the atrial fibrillation group, LAD, serum hs-CRP concentration,PAP, and HR before operation in the sinus rhythm group were lower (p <0.05), MVA,mLAP, plasma BNP concentration, and QTd were no significant difference. Inaddition MVA was highe,rmLAP, PAP, HR, LAD, plasma BNP concentration, serumhs-CRP concentration, and QTd after operation were lower (p <0.05); QRS durationwas no significant difference both pre-and post-operation between the two groups.One hundred and fourteen (95%) of120successful operation cases wereenrolled in follow-up, including48in sinus rhythm group and66in atrial fibrillationgroup. A total of8cases in both group occurred cardiovascular events at follow-up.Single-variable analysis showed that many parameters measured before opera- tion, including MVA, QRS complex duration, PAP, LAD, mitral regurgitation,tricuspic regurgitation, aortic regurgitation, Wilkins score, joint valve disease, age,disease duration, associated atrial fibrillation, were value to predict future cardiovas-cular events (p <0.05), while multivariate logistic regression analysis showed MVA,LAD, mitral regurgitation, Wilkins score and atrial fibrillation were influent factorsfor cardiovascular events (p <0.05).ROC curve analysis showed that Serum hs-CRP concentration, PtfV1, PWd, andLAD could be viewed as independent predictors of future atrial fibrillation in patientswith rheumatic mitral stenosis (p <0.05). Serum Hs-CRP concentration≥4.03mg/L,PtfV1≤-0.039mmï¹'ms, PWd≥38.5ms, and LAD≥45ms served as a cut-off pointof atrial fibrillation prediction with a sensitivity of80.3%,81.4%,80.0%and80.0%;a specificity of95.3%,81.4%,67.48%and79.1%; and a positive predictive accuracyof44.1%,86.1%,77.1%and68.9%, respectively.Conclusion1. PBMV can significantly change cardiac inflammatory response andelectrophysiological properties, and may be beneficial to improve cardiac functionand prevent arrhythmia.2. PBMV is also safe and effective, and has no additional risk.for rheumaticmitral stenosis with atrial fibrillation under the condition of proper indication andpreparation.3. Serum hs-CRP concentration (≥4.03mg/L), PtfV1(≤-0.039mmï¹'ms),PWd (≥38.5ms) and LAD (≥45ms) before operation may be served as independentpredictors of future atrial fibrillation.4. MVA, LAD (≥55mm), and mitral regurgitation, Wilkins ultrasound score(>10points), and associated atrial fibrillation before operation can be viewed as riskfactors predicting post-operative cardiac events.