Correlation between P-Selectin Level and Left Atrial Function in Rheumatic Mitral Stenosis
Abstract
Background. Mitral stenosis (MS) prevalence remains significant in developing countries because of the prevalence of Rheumatic Heart Disease (RHD). In moderate-severe MS patients, enormous increase in turbulent region and shear stress cause vascular endothelial dysfunction, and as the consequence, it increases the risk of thromboembolic complications. P-selectin is an adhesion molecule that play a role in the inflammation process, where it is expressed rapidly in mere minutes. Left Atrial Volume Index (LAVI) is a superior parameter compared with other two-dimensional echocardiography method to assess left atrial function.Methods. This was a cross-sectional study involving 20 MS moderate-severe patients with mitral valve area (MVA) < 1.5 cm2, to whom successful Percutaneous transvenous Balloon Mitral Valvulotomy (PBMV) was performed. Samples were taken consecutively from May-October 2013 at the National Cardiovascular Center Harapan Kita, Jakarta. Blood samples of P-selectin were collected pre and post-PBMV. The result was statistically analyzed with echocardiography data of LAVI prior PBMV to describe any association between expression of P-selectin and atrial function.
Result.We found no association between LAVI and P-selectin level pre and post-PBMV in MS patients. That is described in the value of pre PBMV ?=-0.103 (95% CI -0.251-0.045) with p=0.16 and post-PBMV ?= 0.009 (95% CI -0.155-0.172) with p=0.91 We then performed linear regression test with adjusted confounding variable including sex, age, and atrial fibrillation, still we found no association between LAVI and P-selectin level, with the value of pre PBMV ?= -0.154 (95% CI -0.340-0.032) p=0.09 and post PBMV ?= -0.049 (95% CI -0.250-0.152) p=0.61.
Conclusion. There is no difference in P-selectin level pre and post PBMV. There is no association between poor LAVI value and expression of P-selectin pre and post PBMV in MS.
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References
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27. Pachos GK and Fritzgerald G. Circadian Clocks and Vascular Function. Circ Res. 2010; 106:833-841.
2. Keren G, Etzion T, Sherez J, et al. Atrial fibrillation and atrial enlargement in patients with mitral stenosis. Am Heart J 1987; 114: 1146–55.
3. Mohr JP, Albers GW, Amarenco P, et al. Etiology of stroke. Stroke J. 1997:28:1501-1506.
4. Blume GG, McLeod CJ, Barnes ME, Seward JB, Pellikka PA, Bastiansen PM, et al. Left atrial function: physiology, assessment, and clinical implications. Eur J Echocardiogr. 2011 Jun;12(6):421-30.
5. Beswilan J, Cuyco RE, Tucay ES, Flores BV, Santos RJ, et al. Left Atrial Volume Index (LAVI) is a predictor of Exercise Functional Capacity in Patients with Rheumatic Mitral Stenosis. Phil Heart Center. 2008; 14(1): 14-19.
6. Stefano, G, Zhao H, Schulucter M, Hoit BD. Assesment of echocardiographic left atrial size: accuracy of M- mode and two dimensional methods and prediction of diastolic dysfunction. Echocardiography. 2012 Apr;29 (4); 379-84.
7. Lang RM, Bierig M, Devereux RB, Flachskampf FA, et al; Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiography. 2005;18:1440 –1463.
8. Libby P and Simon DL. Inflammation and Thrombosis: The Clot Thickens. Circulation. 2001;103:1718-1720.
9. Zimmerman GA, Presscot SM, and McIntyre TM.Endothelial Interactions with granulocytes: tethering and signaling molecules. Immunology Today.1992. 13(3): 93-98.
10. Ritchie JL, Alexander HD, Rea IM. Flow cytometry analysis of platelet P selectin expression in whole blood-methodological considerations. Clin Lab Haematol 2000; 22:359–363.
11. Chen MC, Wu CJ, Yip HK, Chang HW, Fang CY, Yu TH, Fu M. Left atrial platelet activity with rheumatic mitral stenosis: correlation study of severity and platelet P-selectin expression by flow cytometry. 2003. Nov;124(5):1663-9.
12. Carabello BA. Modern management of Mitral stenosis. Circulation. 2005;112:432-437.
13. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, et al; Guidelines and Standards Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice. European Journal of Echocardiography. 2009;10:1-25.
14. Remenyi B, Wilson N, Steer A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease an evidence-based guidelineWHO. Macmillan. 2012 May 9; 297-309.
15. Nobuyoshi M, Takeshi A, Shirai S, Hamasaki N, Yokoi H. Percutaneous Balloon Mitral Valvuloplasty: A Review. Circulation. 2009;119:211-219.
16. Patel DA, Lavie CJ, Milani RV, Ventura HO, M. Left Atrial Volume Index Predictive of Mortality Independent of Left Ventricular Geometry in a Large Clinical Cohort With Preserved Ejection Fraction. Mayo Clin Proc. August 2011;86(8):730-737.
17. Chen MC, Chang HW, Juang SS, Yip HK, Wu CJ. Increased Plasma Levels of Soluble P-Selectin in Rheumatic Mitral Stenosis.2004. July;(126):1: 54-58.
18. Shaikh Q, Ahmed B, Ahmed M, et al. Left atrial volumes and associated stroke subtypes. BMC Neurology. 2013;13:14.
19. Avirala S, Kumar S, O`Sullivan DM, et al.
Echocardiographic predictors of left atrial appendage thrombus formation. J. Am. Soc. Echocardiogr. 2011May: 24 (5): 499-505.
20. Adavane S, Santhosh S, Karthikeyen S, Balachander J, et al. Decrease in left atrium volume after successful ballon mitral valvuloplasty: an echocardiographic and hemodynamic study. Echocardiography. 2011 Feb; 28 (2):154-60.
21. Angleton P, Chandler WL, Schmer G. Diurnal variation of tissue-type plasminogen activator and its rapid inhibitor (PAI-1). Circulation 1989; 79:101–106.
22. Barbaux SC, Blankenberg S, Rupprecht HJ, Francomme C, et al. Association Between P-Selectin Gene Polymorphisms and Soluble P-Selectin Levels and Their Relation to Coronary Artery Disease. ArteriosclerThrombVasc Biol. 2001;21:1668-1673.
23. Ponthieux A, Herbeth B, Droesch S, Haddy N, et al. Biological determinants of serum ICAM-1, E-selectin, P-selectin and L-selectin levels in healthy subjects: the Stanislas study. 2004 Feb;172(2):299-308.
24. Goetta A, Ittenson A, Hoffmanns P, et al. Increased expression of P-selectin in patients with chronic atrial fibrillation. Pacing ClinElectrophysiol. 2000 Nov; 23:1872-5.
25. Kovacs IB, Murphy M, Barin E, et al. Effect of warfarin on arterial thrombogenesis: problems on monitoring. Am J Hematol 1993; 42:322–327.
26. Mieszczak C, Winther K. Does warfarin enhance platelet activity? Eur J ClinPharmacol 1996; 84:285–287.
27. Pachos GK and Fritzgerald G. Circadian Clocks and Vascular Function. Circ Res. 2010; 106:833-841.
Published
2015-11-21
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How to Cite
Shanti, P., Yuniadi, Y., & Haryono, N. (2015). Correlation between P-Selectin Level and Left Atrial Function in Rheumatic Mitral Stenosis. Indonesian Journal of Cardiology, 35(3), 150-6. https://doi.org/10.30701/ijc.v35i3.426
Section
Clinical Research
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