Pulmonary Artery Haemodynamic Properties in Patients with Pulmonary Hypertension Secondary to Rheumatic Mitral Stenosis

Background: Objective of the study was to provide insight on the immune response in patients of rheumatic heart disease, mitral stenosis and evaluation of various cytokines in pulmonary hypertension secondary to rheumatic heart disease.Methods: Total 163 subjects, more than 18 year of age, were enrolled in this study. 84 subjects with rheumatic mitral stenosis (group A) diagnosed on two-dimensional echocardiography (2D echo) and 79 normal healthy volunteers (group B). Patients with mitral stenosis were further divided into subgroups based on severity of mitral stenosis [mitral valve area (MVA >1 cm2 and MVA <1 cm2) (subgroup Aa and Ab)] and presence or absence of pulmonary hypertension [pulmonary arterial systolic pressure (PASP >36 mm Hg) (subgroup Ac and Ad)]. Interleukins IL-6, IL-10, IL-18, tumour necrosis factor alpha (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) levels were assessed in both groups.Results: Mean IL-6, IL-10, IL-18, TNF-α and hs-CRP in group A and group B was 6.57±3.53 and 2.73±1 (p≤0.001), 8.185±2.8 and 3.51±0.86 (p≤0.001), 136.31±89.0 and 47.96±9.76 (p≤0.001), 21.26±18.59 and 5.36±3.57 (p≤0.001), 4.69±6.3 and 2.63±2.22 (p≤0.008) respectively. On subgroup analysis mean TNF-α in subgroup Aa was 20.71±16.84, while in subgroup Ab was 7.56±1.93 (p≤0.001). Mean IL-10 in subgroup Ac and Ad was 8.74±3.29 and 7.47±1.82, respectively. Differences in levels of other cytokines in these subgroups were not found statistically significant.Conclusions: This study finds increased IL-6, IL-10, IL-18, TNF-α and hs-CRP levels in subjects with rheumatic mitral stenosis. Subjects with severe mitral stenosis had increased TNF-α levels. Subjects of mitral stenosis having pulmonary hypertension had increased IL-10 levels.

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Pulmonary Hypertension in Rheumatic Mitral Stenosis—Influence of Balloon Mitral Valvotomy

Percutaneous Mitral Valvotomy ◽

10.5005/jp/books/11497_48 ◽

2012 ◽

pp. 412-412

Author(s):

Harikrishnan S ◽

Chandrasekharan Kartha

Keyword(s):

Pulmonary Hypertension ◽

Mitral Stenosis ◽

Rheumatic Mitral Stenosis ◽

Mitral Valvotomy

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The active molecular form of plasma adrenomedullin is extracted in the pulmonary circulation in patients with mitral stenosis: possible role of adrenomedullin in pulmonary hypertension

Clinical Science ◽

10.1042/cs1000061 ◽

2000 ◽

Vol 100 (1) ◽

pp. 61-66 ◽

Cited By ~ 4

Author(s):

Toshio NISHIKIMI ◽

Seiki NAGATA ◽

Tatsuya SASAKI ◽

Fumiki YOSHIHARA ◽

Noritoshi NAGAYA ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Left Atrium ◽

Pulmonary Circulation ◽

Mitral Stenosis ◽

Molecular Form ◽

Femoral Vein ◽

Active Form ◽

Molecular Forms ◽

Main Site

Adrenomedullin (AM), a novel hypotensive peptide, preferentially dilates pulmonary vessels rather than systemic vessels. This suggests the possibility that AM is a circulating hormone which participates in regulation of the pulmonary circulation. A recent study revealed that two molecular forms of AM, i.e. a mature, active form of AM (AM-m) and an intermediate, inactive, glycine-extended form of AM (AM-Gly), circulate in human plasma. In the present study we investigated the production and clearance sites and pathophysiological significance of the two molecular forms of AM in the pulmonary circulation in patients with mitral stenosis. We measured the plasma levels of AM-m and total AM (AM-T; AM-m+AM-Gly) using a recently developed specific immunoradiometric assay, and thus calculated plasma AM-Gly levels, in blood samples obtained from the femoral vein, pulmonary artery, left atrium and aorta of 28 consecutive patients with mitral stenosis (20 females and eight males; age 53±10 years). Patients with mitral stenosis had significantly higher venous concentrations of AM-T, AM-Gly and AM-m than age-matched normal controls (AM-T, 15.9±2.5 and 10.6±2.1 pmol/l respectively; AM-Gly, 14.0±2.1 and 9.8±1.9 pmol/l respectively; AM-m, 1.9±0.6 and 1.1±0.3 pmol/l respectively; each P < 0.001). There was a significant decrease in the concentrations of AM-m and AM-T between the pulmonary artery and the left atrium (AM-T, 16.1±2.7 and 14.0±2.4 pmol/l respectively; AM-m, 2.0±0.6 and 0.7±0.2 pmol/l respectively; each P < 0.001); however, there were no differences in plasma AM-Gly levels between the pulmonary artery and the left atrium (14.1±2.3 and 13.5±2.3 pmol/l respectively). The venous concentrations of AM-m, AM-Gly and AM-T showed similar correlations with mean pulmonary artery pressure (AM-T, r = 0.67; AM-Gly, r = 0.63; AM-m, r = 0.59; each P < 0.001) and total pulmonary vascular resistance (AM-T, r = 0.77; AM-Gly, r = 0.70; AM-m, r = 0.75; each P < 0.001). These results suggest that the plasma concentration of AM-m is increased in parallel with those of AM-Gly and AM-T, and that the main site for clearance of AM-m from the plasma is the lung; the extracted AM-m in the lungs may help to attenuate the increased pulmonary arterial resistance in secondary pulmonary hypertension due to mitral stenosis.

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Pulmonary Hypertension in Mitral Valve Disease -- Rheumatic Mitral Stenosis Versus Organic Mitral Regurgitation: The Doppler-Echocardiographic Study Revisited

10.21203/rs.3.rs-605150/v1 ◽

2021 ◽

Author(s):

Nithima Ratanasit ◽

Khemajira Karaketklang ◽

Prayuth Rasmeehirun ◽

Roongthip Chanwanitkulchai

Keyword(s):

Pulmonary Hypertension ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Pulmonary Artery ◽

Mitral Valve Disease ◽

Mitral Stenosis ◽

Severe Disease ◽

Pulmonary Regurgitation ◽

Valve Disease ◽

Volume Index

Abstract Purpose: The aims of the study were to determine the factors associated with PH among patients with mitral valve disease, and the similarities and differences in the subgroups of mitral stenosis (MS) and mitral regurgitation (MR). Methods: Patients with isolated moderate to severe organic mitral valve disease were prospectively enrolled. Pulmonary hypertension (PH) was defined echocardiographically as pulmonary artery systolic pressure > 50 mmHg. Patients with MS who had mitral valve area > 1.5 cm2 and patients with MR who had effective regurgitant orifice area < 20 mm2 were excluded. Results: There were 318 patients (mean age 54.3 ± 15.5 years, 57.6% female, 66.7% MR). PH was present in 119 (37.4%) patients (48.1% and 31.8% in MS and MR, respectively). Severe mitral valve disease was reported in 245 (77.0%) patients. Left atrial (LA) diameter and pulmonary artery pressure were significantly higher in patients with MS. Dyspnea, LA volume index, significant tricuspid and pulmonary regurgitation, severe mitral valve disease and the presence of MS were independently associated with PH. Among patients with MS, LA volume index and severe disease were independently associated with PH. Significant tricuspid and pulmonary regurgitation, LA volume index and severe disease were independently associated with PH in patients with MR. Conclusions: PH is common in patients with mitral valve disease. LA volume index and severe disease were, in common, independently associated with PH in patients with mitral valve disease and in the subgroups of MS and MR.

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FACTORS RESPONSIBLE FOR INSIGNIFICANT DECREASE IN PULMONARY ARTERY PRESSURE IMMEDIATELY AFTER PER CUTANEOUS TRANS-MITRAL COMMISSUROTOMY IN PATIENTS OF RHEUMATIC MITRAL STENOSIS

Khyber Medical University Journal ◽

10.35845/kmuj.2019.18817 ◽

2019 ◽

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Mitral Stenosis ◽

Odds Ratio ◽

Duration Of Symptoms ◽

Artery Pressure ◽

Rheumatic Mitral Stenosis ◽

History Of ◽

Mitral Commissurotomy

OBJECTIVES: To determine the factors responsible for insignificant decrease in pulmonary artery pressure immediately after percutaneous trans-mitral commissurotomy (PTMC) in patients of rheumatic mitral stenosis. METHODS: This cross-sectional study was conducted on patients undergoing PTMC at Cardiology Unit, Lady Reading Hospital, Peshawar, Pakistan from 11th February, 2016 to 28th February, 2018. Pulmonary artery pressure (PAP) was noted before and after PTMC through echocardiography. Data was analyzed with SPSS Version 20.0, categorical and continuous variables were described as frequencies/percentages and mean±SD respectively. Odds Ratio was determined for factors negatively affecting the fall in PAP. RESULTS: Out of 159 patients, 108 (67.9%) were females. Mean age was 25.38±10.67 years. PAP was insignificantly decreased in patients >30 years (p>0.05), symptoms for >5 years (p>0.05), left atrium diameter >4.5cm (p>0.05), atrial fibrillation (p>0.05), right ventricle diameter >2.5cm (p>0.05) and NYHA IV dyspnea (p>0.05). Odds Ratio for failure of significant decrease in PAP immediately post-PTMC was 1.68 for age more than 30 years, 1.10 for symptoms more than 5 years, 3.73 for LA diameter more than 4.5 cm, 2.31 for RV diameter more than 2.5 cm , 2.32 for history of atrial fibrillation and 6.71 for NYHA IV dyspnea. CONCLUSION: Factors which negatively affect the immediate fall in PAP post-PTMC are age >30years, duration of symptoms >5years, LA diameter >4.5cm, history of atrial fibrillation, RV diameter >2.5cm and NYHA IV dyspnea and hence are the poor predictors of successful PTMC while NYHA IV dyspnea has highest Odds for insignificant decrease.

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