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

Abstract 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.