Late mitral restenosis after percutaneous commissurotomy: Predictive value of inflammation and extracellular matrix remodeling biomarkers.

Background: The role of chronic inflammation in mitral restenosis after percutaneous mitral commissurotomy (PMC) is still controversial.

Aims: We sought to assess the predictive value of inflammation and extracellular matrix (ECM) remodeling biomarkers in late mitral restenosis after PMC.

Methods: We prospectively enrolled 155 patients (mean age 46.2±11 years) with at least 5 year follow up after primary PMC. Serum levels of high sensitive C-Reactive Protein (hs-CRP), matrix metalloproteinases MMPs, tissue-specific inhibitors of matrix metalloproteinases TIMPs, and tumor necrosis factor α (TNFα)] were measured.

Results: Late mitral restenosis occurred in 55 patients (35.5%). The independent predictors of late mitral stenosis were: age> 55 years [HR10.51 (95%CI 1.12-95.9); p=0.037]; no long acting penicillin therapy [HR 18.1 (95% CI 2.6-122.9); p=0.003]; TNFα > 80 ng/ml [HR 5.85 (95% CI 1.1-31.42); p=0.039]; and TIMP-2 > 289 ng/ml [HR 0.52 (95% CI 0.22-0.95); p=0.045].

Conclusion: Chronic inflammation and ECM remodeling are involved in late mitral restenosis after PMC.