C-reactive protein elevation independently influences the procedural success of percutaneous balloon mitral valve commissurotomy.

BACKGROUND

Markers of systemic inflammation including C-reactive protein (CRP) appear to predict morbidity and mortality in various clinical conditions. The presence of systemic inflammation and its impact on the procedural success of percutaneous balloon mitral valve commissurotomy (PBMC) in patients with rheumatic mitral stenosis has not been previously demonstrated.

METHODS

Measurements of CRP with a high-sensitivity assay were performed at the time of PBMC or during post-procedural follow-up in 119 patients with mitral stenosis of rheumatic morphology. Patients were questioned to exclude confounders of CRP elevation and categorized into undetectable (< or =0.10 mg/L) and detectable (>0.10 mg/L) CRP levels. Detectable levels were further classified into assay range (>0.10 and < or =6.0 mg/L) and elevated (>6.0 mg/L).

RESULTS

CRP was detectable in 76% of patients and elevated (>6.0 mg/L) in 36% of patients studied. Procedural success occurred in 89% of patients with undetectable CRP, as compared with only 67% in patients with detectable CRP (P =.028). This effect remained after controlling for age and valve score (previously described predictors of PBMC success).

CONCLUSIONS

Systemic inflammation is common in patients with rheumatic mitral valve stenosis, and the relationship between procedural success and CRP suggests persistent inflammation may affect the results of PBMC.