Abstract Introduction Rheumatic mitral stenosis (RMS) is prevalent in low- and middle-income countries (LMICs), including Indonesia. The chronic inflammatory state in RMS patients contributes to progressive valvular damage. Recent studies have identified that the neutrophil-to-lymphocyte ratio (NLR) is significantly higher in patients with severe RMS compared to those with mild and moderate RMS. However, the association between other white blood cell (WBC)-based inflammatory markers, such as the platelet-to-lymphocyte ratio (PLR) and the monocyte-to-lymphocyte ratio (MLR), and the severity of RMS remains underexplored. Purpose The objective of this study was to assess the association between WBC-based inflammatory markers and the severity of RMS. Methods This cross-sectional study was conducted from May 2014 to September 2022, utilising data from the Valvular Heart Disease Registry of a tertiary referral hospital in Indonesia. The study included patients with RMS, with or without pulmonary hypertension, who did not have other severe valvular abnormalities. All subjects underwent transthoracic echocardiography. Severe RMS was defined as a mitral valve area (MVA) ≤ 1 cm², while mild-to-moderate RMS was defined as an MVA 1 cm². The Mann-Whitney U test was used to compare inflammatory markers (NLR, PLR, and MLR) between the two groups. Spearman's correlation analysis was performed to assess the relationship between inflammatory markers and MVA. Multivariate linear regression was performed to identify independent predictors of MVA. A p-value of 0.05 was considered statistically significant. Results A total of 206 subjects (mean age 43.58 ± 11.04 years; 73.8% female) were enrolled in this study, with 154 in the severe RMS group and 52 in the mild-to-moderate RMS group. The Mann-Whitney U test showed that the severe RMS group had significantly higher NLR (2.79 2.00–3.84 vs. 2.29 1.74–3.45, p = 0.024) and PLR (135.98 104.29–172.07 vs. 118.97 93.47–156.75, p = 0.032) compared to the mild-to-moderate RMS group. No significant difference was observed in MLR between the two groups (p = 0.75). Spearman's correlation revealed weak but significant negative correlations between NLR and MVA (ρ = -0.256, p 0.001) and between PLR and MVA (ρ = -0.223, p = 0.002). The multivariate linear regression revealed that a higher NLR (p = 0.004) was an independent predictor of a smaller MVA. However, PLR was not significantly associated with MVA in this model. Conclusion The neutrophil-to-lymphocyte ratio is associated with the severity of rheumatic mitral stenosis. A higher NLR is an independent predictor of a smaller mitral valve area. NLR could serve as a simple, accessible, and cost-effective marker for assessing RMS severity in LMICs, where imaging modalities are limited.Boxplots of NLR and PLR by RMS Severity Association of NLR and PLR with MVA
Laila et al. (Sat,) studied this question.