Pre-procedural and procedural predictors of significant mitral regurgitation following percutaneous mitral commissurotomy with Inoue balloon technique: a new face of an old story

Despite the high technical expertise in percutaneous mitral commissurotomy [PMC], mitral regurgitation [MR] remains a major procedure-related complication. The aim of this work is to find out the most sensitive and applicable predictors of development of significant mitral regurgitation [SMR] following percutaneous mitral commissurotomy using Inoue balloon technique. We studied the pre-procedural [Clinical, echocardiography, and hemodynamic] and procedural predictors of significant mitral regurgitation [identified as increase of >/= 2/4 grades of pre-PMC MR by color Doppler flow mapping] following valvuloplasty using Inoue balloon in 54 randomized patients with severe mitral stenosis. Multiple stepwise logistic regression analysis was performed for variables found positive on univariate analysis to determine the most important predictor [s] of developing SMR. The incidence of SMR following PMC using Inoue technique was 18.5% [10 patients]. MV scoring systems were the only variables that showed significant differences between both groups [Group A without SMR and Group B with SMR]. However, no clinical, other echocardiographic measurements, hemodynamic or procedural variables could predict the development of SMR. Using multiple regression analysis, the best predictive factor for the risk of SMR post Inoue BMV was the total MR-echo score with a cut-off point of 7 and a predictive percentage of 97.7%. The total MR-echo score is the only independent predictor of SMR following PMC using Inoue technique with a cut-off point of 7

Correlation between D-dimer, N- Terminal pro atrial natriuretic peptide, and left atrial size in patients with chronic nonvalvular atrial fibrillation

In patient with chronic nonvalvular atrial fibrillation [AF], the correlation between prothrombotic marker D-dimer, N-terminal pro-atrial natriuretic peptide [NT-ANP], and left atrial [LA] size is not completely understood also, the precise effect of hypercoagulability is not well known to date. Therefore, this study was performed to determine whether prothrombotic state presented by increase level of D-dimer in patients with chronic nonvalvular AF, as well as NT-ANP were correlated with left atrial size and risk of thromboembolic events. A 43 patients with chronic nonvalvular atrial fibrillation with prior cerebrovascular cardioembolic event and 35 without cardioembolic event were studied for echocardiographic LA size, D-dimer level and NT-ANP. the LA size and D-dimer were significantly high in patients with cardioembolic stroke than patients without cardioembolic stroke [P value <0,05], no significant difference in NT-ANP in both groups [P value >0.05], a positive linear correlation was found between the increased D-dimer level and LA size [r=0.42, P<0.01]. No correlation was found between NT-ANP level and the LA size. the present study concluded that the prothrombotic marker D-dimer is elevated in patient with chronic nonvalvular AF, this marker showed positive linear correlation to the left atrial size and cardioembolic risk of stroke making it a significant marker for risk stratification for those patient whom at high risk, the result also opened a rational for use of warfarin in those patient with elevated D-dimer