Romatizmal Mitral Darlığı Olan Hastalarda Wilkins Ekokardiyografik Skor ve Nötrofil Lenfosit Oranı Arasındaki İlişki

Year 2020, Volume: 9 Issue: 1, 35 - 40, 08.04.2020

Zehra Erkal

https://doi.org/10.5505/abantmedj.2020.83097

Abstract

AMAÇ: Romatizmal mitral darlığı (RMS) olan hastalarda Wilkins ekokardiyografik skoru (WS) perkütan mitral balon valvuloplastiye (PMBV) uygunluğu değerlendirmede yaygın olarak kullanılmaktadır. WS 11'den yüksek olanlar PMBV için uygun kabul edilmemektedir. Daha önceki çalışmalarda RMS' un ilerlemesinde inflamasyonun rolü gösterilmiştir. Bu çalışmada inflamasyonun göstergelerinden olan nötrofil/lenfosit oranının (NLR) yüksek WS' nu göstermedeki rolü araştırıldı.
GEREÇ ve YÖNTEMLER: Bu retrospektif çalışmaya orta-ciddi RMS olan hastalar alındı. Hastaların transtorasik ve transözefageal ekokardiyografik görüntüleri incelendi. Hastalar WS' na göre iki gruba ayrıldı; grup 1'de WS≤ 11 olanlar, grup 2'de WS>11 olanlar. Grupların ekokardiyografik ve hematolojik parametreleri karşılaştırıldı.
BULGULAR: Çalışmaya 93'ü kadın (%80) 115 hasta alındı. Grup 1'de 72 hasta (ortalama yaş 43.7±12.0) ve grup 2'de 43 hasta (ortalama yaş 52.7±11.3) vardı. Grup 1'de ortalama WS 7.4±2.0 iken grup 2'de 12.4±0.7 idi. NLR değeri grup 2'de grup 1'den anlamlı olarak daha yüksek saptandı (sırasıyla 3.8±0.5 ve 2.6±0.9, p<0.001). NLR için 3.09 sınır değeri yüksek WS' nu göstermede %100 duyarlılık ve %78 özgüllüğe sahip bulundu.
SONUÇ: RMS' lu hastalarda NLR değeri WS>11 olması ile bağımsız ilişkilidir.

Keywords

Biyometrik parametreler, Cerrahi süresi, Fakoemülsifikasyon, Nükleer Skleroz, Ultrason süresi

Relationship Between Wilkins Echocardiographic Score and Neutrophil to Lymphocyte Ratio In Patients with Rheumatic Mitral Stenosis

Abstract

OBJECTIVE: Wilkins echocardiography score (WS) is commonly used for patients with rheumatic mitral stenosis (RMS) to evaluate their eligibility for percutaneous mitral balloon valvuloplasty (PMBV) treatment. Patients with WS of higher than 11 are not eligible for PMBV treatment. Previous studies demonstrated that inflammation might play a role in RMS progression. The purpose of this study was to investigate the role of neutrophil/lymphocyte ratio (N/L ratio), which is an indicator of inflammation in predicting high WS.
MATERIALS and METHODS: In this retrospective study, we investigated 115 patients (93 females, 22 males) with moderate to severe RMS. Transthoracic and transesophageal echocardiography reports were analysed. Patients were divided into two groups according to their Wilkins scores. Patients with a WS ≤ 11 were included in Group 1 and those with a WS >11 were included in Group 2. The echocardiographic and haematological parameters of the groups were compared.
RESULTS: Group 1 consisted of 72 patients (mean age 43.7±12.0) and group 2 consisted of 43 patients (mean age 52.7±11.3). In Group 1, the mean WS was 7.4±2.0 while it was 12.4±0.7 in Group 2. The N/L ratio was 3.8±0.5 in Group 2 and it was significantly higher than that of Group 1, which was 2.6±0.9 (p<0.001). The N/L ratio cut-off point was 3.09 with a sensitivity of 100% and specificity of 78% in predicting RMS patients with high WS.
CONCLUSION: The N/L ratio was independently associated with WS>11 in patients with RMS.

Keywords

Biometric parameters, Nuclear sclerosis, Phacoemulsification, Surgery time, Ultrasound time

References

• Goldstein I, Rebeyrotte P, Parlebas J, Halpern B. Isolation from heart valves of glycopeptides which share immunological properties with Streptococcus haemolyticus group A polysaccharides. Nature. 1968; 24;219(5156):866-8
• Guilherme L, Cunha-Neto E, Coelho V, Snitcowsky R, Pomerantzeff PM, Assis RV, Pedra F, Neumann J, Goldberg A, Patarroya ME. Human heart-infiltrating T-cell clones from rheumatic heart disease patients recognize both streptococcal and cardiac proteins. Circulation. 1995; 1;92(3):415-20.
• Alyan O, Metin F, Kacmaz F, Ozdemir O, Maden O, Topaloglu S, Demir AD, Karahan Z, Karadede A, İlkay E. High levels of high sensitivity C-reactive protein predict the progression of chronic rheumatic mitral stenosis. J Thromb Thrombolysis. 2009 ;28(1):63-9.
• Hasan-Ali H, Mosad E. Changes in platelet, coagulation, and fibrinolytic activities in mitral stenosis after percutaneous mitral valvotomy: Role of hemodynamic changes and systemic inflammation. Clin Appl Thromb Hemost. 2015; 21(4):339-47.
• Sahin S, Sarıkaya S, Alcelik A, Erdem A, Taslıyurt T, Akyol L, Altunkas F, Aktas GA, Karaman K. Neutrophil to lymphocyte ratio is a useful predictor of atrial fibrillation in patients with diabetes mellitus. Acta Medica Mediterranea, 2013; 29; 847-51.
• Aktas GA, Sit M, Dikbas O, Erkal H, Altınordu R, Erkus E, Savlı H. Elevated Neutprohil to lymphocyte ratio in the diagnosis of Hashimoto’s thyroiditis. Rev Assoc Med Bras 2017; 1065-68.
• Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J 1988; 60(4):299-308.
• Paiva M, Correia AS, Lopes R, Gonçalves A, Almeida R, Almeida PB, Frutuoso C, Silva JC, Maciel MJ. Selection of patients for percutaneous balloon mitral valvotomy: is there a definitive limit for the Wilkins score? Rev Port Cardiol. 2013; 32(11):873-8.
• Post JR, Feldman T, Isner J, Herrmann HC. Inoue balloon mitral valvotomy in patients with severe valvular and subvalvular deformity. J Am Coll Cardiol. 1995; 25(5):1129-36.
• Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol. 2017; 11;70(2):252-89.
• Nobuyoshi M, Arita T, Shirai S, Hamasaki N, Yokoi H, Iwabuchi M, Yasumoto H, Nosaka H. Percutaneous balloon mitral valvuloplasty: a review. Circulation. 2009; 3;119(8): e211-9.
• Cunningham MW. T cell mimicry in inflammatory heart disease. Mol Immunol. 2004; 40(14-15):1121-7.
• Chopra P, Gulwani H. Pathology and pathogenesis of rheumatic heart disease. Indian J Pathol Microbiol 2007; 50(4):685-97.
• Angeles-Valdés J, Uruchurtu Chavarín E. Percutaneous mitral valvuloplasty. Arch Cardiol Mex. 2005; 75(3):350-62.
• Mukhopadhyay S, Pandit BN, Saran RK, Mazumdar K, Yusuf J, Minhas HS, Trehan V, Tyagi S. Systemic and local levels of fetuin-a in calcified mitral valves of rheumatic heart disease. J Heart Valve Dis. 2014; 23(1):55-65.
• Nunes MC1, Tan TC, Elmariah S, do Lago R, Margey R, Cruz-Gonzalez I, Zheng H, Handschumacher MD, Inglessis I, Palacios IF, Weyman AE, Hung J. The echo score revisited: Impact of incorporating commissural morphology and leaflet displacement to the prediction of outcome for patients undergoing percutaneous mitral valvuloplasty. Circulation. 2014; 129(8):886-95.
• Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC. Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation. 2002; 105(12):1465-71.
• Ekinci M, Duygu H, Acet H, Ertas F, Cakir C, Berilgen R, Nazli C, Ergene O. The efficiency and safety of balloon valvuloplasty in patients with mitral stenosis and a high echo score: mid- and short-term clinical and echocardiographic results. Turk Kardiyol Dern Ars. 2009; 37(8):531-7.