Efeito da valvoplastia mitral percutânea por balão no nível de citocinas em pacientes com estenose mitral reumática

Abstract

Introduction: Abnormal inflammatory response in rheumatic heart disease (RHD) can lead to structural changes of mitral valve and ultimately to mitral stenosis (MS). Percutaneous mitral commissurotomy (PMC) is the main treatment of severe MS, which might have an impact on release of cytokines. However, the effects of valve intervention on cytokine secretion is unknown. Objectives: This study aimed to determine the effects of PMC on the secretion of cytokines, chemokines and growth factors in patients with rheumatic MS. Methods: We enrolled 18 patients with severe MS who underwent PMC in the Hospital das Clínicas of the Federal University of Minas Gerais (HC-UFMG). A control group was composed of 12 healthy volunteers. Concentrations of cytokines, chemokines and growth factors were measured in control group and in patients with MS immediately before PMC and 4-11 days after the procedure using a capture bead immunoassay. Results: Compared to control group, patients with MS before PMC demonstrated higher levels of growth factor PDGF, chemokines IP-10, MCP-1, MIP-1 α, MIP-1 β, eotaxin, RANTES and IL-8, inflammatory cytokines IL-1β, IL-17 and IFN-γ and anti-inflammatory molecule IL-1RA and Th2 cytokine IL-4. On the other hand, the levels of inflammatory cytokines IL-6 and IL-12 and Th2 cytokine IL-13 were lower in patients with MS prior to PMC compared to control group. After PMC, there was a significant reduction of plasma levels of growth factors PDGF, VEGF and FGF, proliferative factors IL-2, IL-7 and IL-15, chemokine eotaxin, inflammatory cytokines IL-1β, IL-6 and IL-12p70 and Th2 cytokines IL-4 and IL-5. Interestingly, there was no significant change in the levels of down-regulatory cytokine IL-10 and IL-1RA. Importantly, the levels of the measured cytokines did not increase after intervention. Conclusion: After relief of valve obstruction with improvement in left atrial pressure, serum levels of innate cell-derived inflammatory cytokines significantly decreased. This finding suggests that the improvement of hemodynamic parameters leads to less injury and, thus, less inflammation.