ESC Journals
ICMR
Association of atrial fibrillation (AF) is a common cause of morbidity and mortality in patients with rheumatic heart disease (RHD). Association of Atrial Fibrillation with inflammation is well delineated in nonvalvular AF as compared to Rheumatic AF. This study evaluated the presence of atrial inflammation, in patients with AF and rheumatic mitral stenosis (MS), using cardiac MRI and its correlation with inflammatory markers.
Twenty RHD patients with predominant mitral stenosis were recruited for the study. Ten patients had persistent AF, three had paroxysmal AF and seven were in sinus rhythm. Patients with AF had lower mitral valve areas. Cardiac MRI showed evidence of late gadolinium enhancement (LGE) in the atrial wall in 61.54% (8/13) of patients with AF as compared with only 20% (1/5; p < 0.05) of patients in sinus rhythm. Mean levels of IL-6 were also significantly higher in patients with AF (10.62 ± 5.92 pg/mL versus 4.37 ± 2.68 pg/mL; P= 0.017). IL6 with a cutoff of ≥ 6.5 pg/mL was associated with a sensitivity of 76.92 % and specificity of 71.43 % for prediction of AF. There was also significant association between high IL-6 levels and LGE on MRI (13.13 ± 5.75 pg/mL vs 5.29 ± 3.23pg/mL; P < 0.05)
Patients with MS who developed AF show evidence of atrial inflammatory sequelae in the form of fibrosis as suggested by LGE on cardiac MRI. Systemic inflammation in the form of elevated IL-6 levels correlated significantly with atrial fibrosis and AF.
Table 1: MS patients with or without AF
Clinical Features | Rhythm | P-Value | ||
---|---|---|---|---|
NSR (n = 7) | AF (n = 13) | |||
Mean Valve Area (cm2) | 1.28 ± 0.35 | 0.83 ± 0.26 | < 0.01 | |
Mean Diastolic Gradient (mmHg) | 6.29 ± 2.2 | 11.92 ± 5.65 | <0.01 | |
Wilkin Score | 7 ± 0.816 | 8.46 ± 1.66 | 0.04 | |
LVEF % (non indexed) | 59.57 ± 1.13 | 58.77 ± 2.89 | 0.49 | |
LA Volume with MRI (ml) | 127.50 ± 51.32 | 284.33 ± 133.12 | <0.01 | |
Inflammatory Markers | hs-CRP (mg/L) | 5.59 ± 3.89 | 3.94 ± 3.47 | 0.34 |
IL6 (pg/mL) | 4.37 ± 2.68 | 10.62 ± 5.92 | 0.017 | |
sCD-40L (ng/mL) | 3.72 ± 3.73 | 4.77 ± 2.80 | 0.48 | |
Atrial LGE | 0 (0%) | 8 (61.5%) | 0.04 |
Abstract P89 Figure. Image 1: Cardiac MRI showing LGE