Effect of Percutaneous Transvenous Mitral Commissurotomy on Plasma Apelin Level in Mitral Stenosis Patients
|Vinu Wilson1, Namit Gupta2, Pankaj Prabhakar1, Lakshmy Ramakrishnan3, Sandeep Seth2 and Subir Kumar Maulik1*|
|1Department of Pharmacology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India|
|2Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India|
|3Department of Cardiac-Biochemistry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India|
|Corresponding Author :||Maulik SK, MD, PhD
Professor, Department of Pharmacology
4th floor, Teaching block, All India Institute of Medical Sciences
Ansari Nagar, New Delhi-110029, India
Tel: +91 11 26593540; +91 9958318973
Fax: 011-26588641; 26588663
E-mail: [email protected]
|Received November 27, 2013; Accepted January 17, 2014; Published January 21, 2014|
|Citation: Wilson V, Gupta N, Prabhakar P, Ramakrishnan L, Seth S, et al. (2014) Effect of Percutaneous Transvenous Mitral Commissurotomy on Plasma Apelin Level in Mitral Stenosis Patients. J Clin Exp Cardiolog 5:283. doi:10.4172/2155-9880.1000283|
|Copyright: © 2014 Wilson V, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Background: Apelin is an endogenous peptide with positive inotropic property secreted by the heart besides other tissues. Plasma apelin levels are altered in chronic heart failure with left ventricular dysfunction. However, the effect of left atrial hemodynamic overload on plasma apelin levels in mitral stenosis (MS) is unknown. In this observational study, we estimated plasma apelin level in MS patients, before and twelve weeks after percutaneous transvenous mitral commissurotomy (PTMC) and compared with plasma brain natriuretic peptide (BNP) levels, mitral valvular pressure gradient and quality of life measure.
Methods: Venous blood samples were drawn from 10 MS patients and 10 age-matched controls, with informed consent. Apelin was estimated by competitive ELISA and BNP using an auto-analyzer. PTMC was done by atrial septal puncture and Inoue balloon. Self-administered Kansas City cardiomyopathy questionnaire (KCCQ) was used to assess quality of life. Variables distributed normally were expressed as mean ± S.D. and others as median (interquartile range) and analyzed using appropriate statistical tests. A p-value<0.05 was considered statistically significant.
Results: MS patients belonged to NYHA class II & III, had pulmonary artery hypertension but left ventricular ejection fraction>50%. Plasma apelin was lower [320 (167, 515) vs. 570 (415, 680) pg/ml; p=0.028] and BNP level higher [44 (15, 117) vs. 6 (5, 10) pg/ml; p=0.001] in MS patients compared to controls, respectively. PTMC decreased mitral valvular pressure gradient [6.7 (5.0, 8.7) vs. 20.5 (12.4, 27.2) mm of Hg; p=0.012] and improved KCCQ score (84 ± 7 vs. 54 ± 10%; p<0.001) but did not change plasma apelin and BNP levels [330 (192, 465) and 42 (19, 86) pg/ml, respectively].
Conclusion: Plasma apelin is depressed and BNP level raised in MS patients. Changes in plasma apelin level may occur slower compared to hemodynamic and functional improvement post PTMC.