Abstract
Mohanan Nair KK et al. Clin Cardiol. 2012;35:35–39
To the Editor:
I read with great interest the article from Mohanan Nair et al. concerning the influence of atrial fibrillation (AF) on the immediate and long term outcome of patients undergoing mitral balloon valvotomy (BMV).1 The authors found evidence that the presence of AF was associated with inferior immediate and long‐term outcome after BMV. They concluded that AF represents a marker for more severe or long‐standing mitral stenosis, and the presence of AF should be a determinant in the decision‐making process regarding treatment options. It is attributed that the chronicity of underlying rheumatic disease and structural changes in the left atrium are more likely to be associated with more severe mitral valve deformity and calcification.
Although the previous study demonstrated that the presence of AF by itself does not unfavorably influence the outcome but is a marker for clinical and morphologic features associated with inferior results after percutaneous mitral valvuloplasty (PMV),2 I agree with Mohanan Nair and his colleagues that AF has a negative impact on the immediate and long‐term outcome after BMV. I have encountered supporting evidence in patients with severe mitral regurgitation, and found that the left atrium and its appendage functions are impaired in patients with severe mitral regurgitation and AF, whereas they are preserved in patients with normal sinus rhythm compared to controls.3 Moreover, in another study, it was observed that left atrial mechanical functions were not completely improved after PMV, even in patients with normal sinus rhythm and in patients with severe mitral stenosis.4 An established relationship exists between the persistence of inflammatory status and progression of rheumatic mitral stenosis.5 The levels of high‐sensitivity C‐reactive protein were found to be positively correlated with mean Wilkins valve score, presence of AF, left atrial diameter, left atrial area, presence of left atrial spontaneous echo contrast, fibrinogen, and MPV, and inversely correlated with mitral valve area in patients with chronic rheumatic mitral stenosis. It has been shown that even if PMV was performed, the disease progression was not stopped. In addition to the chronic inflammation, the presence of AF may contribute to the structural changes with both the atrium and ventricles. It was observed that patients with AF, as opposed to normal subjects, have larger left atria and reduced systolic and diastolic left ventricular function.6
Vecih Oduncu, MD Cardiology Clinic Fatih Medical Park Hospital Fatih, Istanbul, Turkey
References
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