Significance of inflammation-related markers and histopathological features in mitral valve regurgitation

The lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR), C-reactive protein (CRP)-to-lymphocyte ratio (CLR) and fibrinogen-to-albumin ratio (FAR) are well-known indicators of the systemic inflammatory response (SIR). Less is known about the association of SIR with the echocardiographic parameters and the histopathological (HP) aspects of the mitral valve in patients who have undergone cardiac surgery to repair or replace the mitral valve. Information on serum parameters, transesophageal echocardiography findings, and HP results was obtained from 166 patients who had undergone cardiac surgery to address mitral valve regurgitation. Among these patients, 30 were diagnosed with mitral valve prolapse, with 15 cases showing mitral valve flail or chordae rupture. The possible association between SIR, echocardiographic aspects of mitral valve flail and the HP aspect was checked. Fibrosis, hyalinization and myxoid degeneration of the valve were scored under microscope. Hyalinization of the mitral valve had a significant positive association with LMR and PLR (p=0.041 and p=0.03, respectively) and with NLR (p=0.093). A higher fibrosis degree was present in the valves without flail compared with those with flail (p=0.000). The monocyte average values of the group without flail were statistically significantly higher than those in the flail group (p=0.029). An increase of one unit in the value of monocytes was found to decrease the chances of flail [odds ratio (OR) 0.017, p=0.068, significant at p<0.1 level]. SIR parameters can be used to appraise inflammation status in mitral valve disease and to establish the risk of chordae rupture/flail in the case of mitral valve prolapse.