Autoimmune Response Confers Decreased Cardiac Function in Patients with Rheumatic Mitral Lesion following Valve Replacement

Purpose: To explore the effect of autoimmune response on the decreased cardiac function in patients with rheumatic mitral lesion following valve replacement.
Methods: In this case-controlled study, 29 patients who had undergone valve replacement as a result of mitral lesion were enrolled (mean age = 48.7 years). Twenty healthy volunteers were selected as control (mean age = 47.5 years). Plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), high –sensitivity C-reactive protein (hs-CRP) and echocardiographic indices of heart function in the two groups were investigated, respectively. Body mass index (BMI) was also calculated.
Results: TNF-α, IL-6 and hs-CRP levels in plasma were significantly higher than those in controls (p < 0.05; 22.23 pg/mL vs. 13.24 pg/mL, 53.42 pg/mL vs. 9.57 pg/mL, and 2.12 μg/mL vs. 0.97 μg/mL, respectively). The indices of left atrial diameter (LAD), left ventricular end-diastolic diameter (LDD) and isovolumetric contraction time (ICT) were significantly higher (p < 0.05; 4.72 cm vs. 3.78 cm, 4.85 cm vs. 4.37 cm, and 76.38 ms vs. 66.24 ms, respectively), but those of early diastolic velocity (Ea), late diastolic velocities (Aa) and ejection time (ET) were significantly lower (p < 0.05; 7.65 cm/s vs. 16.8 cm/s, 5.56 cm/s vs. 12.9 cm/s, and 261.54 ms vs. 276.14 ms, respectively). Two-dimensional echocardiography obtained the same results.
Conclusion: Valve replacement in patients with rheumatic heart disease (RHD) does not attenuate inflammatory response; rather, autoimmune response would keep affecting decreased heart function in RHD patients who have received mitral valve replacement.

Keywords
Tumor necrosis factor-α; Interleukin-6; High sensitivity C-reactive protein; Mitral lesion; Mitral valve replacement