endothelin-1 and Rheumatic-Heart-Disease

Cardiopathies are high prevalence conditions. Among them, rheumatic carditis is of high relevance in developing countries. Left cardiac chamber changes are associated to endothelial dysfunction and ET-1 levels increase. Pulmonary circulation is then affected, and not seldom leading to pulmonary hypertension (PH). However, the presence of ET-1 and its receptors in the mitral valve itself--promoting pulmonary vascular changes, with increased rheumatic valvular deformation--has not been discussed in the literature.. To determine the expression of endothelin gene and its receptors in rheumatic mitral valves through techniques of molecular genetics.. Twenty-seven patients submitted to mitral valve replacement had their valvular tissue examined to determine the presence of ET-1 genes and their A and B receptors. Histological and molecular analysis of the valves was performed (divided into M1, M2 and M3 fragments), with patients' clinical and epidemiological data collected. Patients were divided into 3 groups (mitral valvopathy, mitroaortic valvopathy, and reoperation patients).. The study showed endothelin-1 gene expression in 40.7% specimens and A receptor in all samples; receptor gene B had lower expression (22.2%).. All patients showed A receptor gene expression. No statistically significant difference was observed in regard to condition severity, expressed according to functional class, and subgroups (mitral valvopathy, mitroaortic valvopathy, and reoperation patients).

Topics: Adolescent; Adult; Aged; Electrophoresis, Agar Gel; Endothelin-1; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Mitral Valve; Polymerase Chain Reaction; Receptors, Endothelin; Rheumatic Heart Disease; Severity of Illness Index; Spectrophotometry; Young Adult

Increased plasma endothelin (ET)-1 concentrations have been observed in patients with rheumatic mitral stenosis (MS). However, the mechanisms of increased circulating ET-1 in patients with MS remain unclear.. We measured plasma concentrations of ET-1 in blood samples from the femoral vein and artery, and right and left atria obtained from 20 patients with moderate-to-severe rheumatic MS before and after percutaneous transluminal mitral valvuloplasty (PTMV) [group 1; 16 patients in chronic atrial fibrillation and 4 patients in sinus rhythm]. In addition, we measured plasma concentrations of ET-1 in the peripheral venous blood samples obtained from 22 control patients (including 14 healthy volunteers in sinus rhythm [group 2] and 8 patients in chronic lone atrial fibrillation [group 3]). Plasma ET-1 concentrations were measured by solid-phase, sandwich enzyme-linked immunosorbent assay.. The peripheral venous plasma concentrations of ET-1 were significantly higher in group 1 patients (2.46 +/- 0.90 pg/mL) than in group 2 and group 3 patients (0.74 +/- 0.42 pg/mL and 0.99 +/- 0.41 pg/mL, respectively [mean +/- SD]; p < 0.0001). However, there was no significant difference in the peripheral venous concentrations of ET-1 between group 2 and group 3 patients. In group 1 patients, the plasma ET-1 concentration in the femoral vein (2.46 +/- 0.90 pg/mL) was significantly higher than that in the right atrium (2.02 +/- 0.69 pg/mL), left atrium (2.11 +/- 0.99 pg/mL), and femoral artery (2.05 +/- 0.75 pg/mL) [p = 0.0001]. The plasma ET-1 concentration in the femoral vein was not correlated with the mean left atrial pressure (r = 0.05; p = 0.838) and mean pulmonary artery pressure (r = 0.07; p = 0.757). The plasma ET-1 concentration in the left atrium was also not correlated with the mean left atrial pressure (r = 0.11; p = 0.656), mean pulmonary artery pressure (r = 0.06; p = 0.788), or mitral valve area (r = 0.02; p = 0.936). Although the area of mitral valve increased significantly (1.06 +/- 0.17 cm(2) vs 1.48 +/- 0.32 cm(2); p < 0.0001), and the mean left atrial pressure (23.0 +/- 5.1 mm Hg vs 17.6 +/- 5.9 mm Hg; p < 0.0001) and mean pulmonary arterial pressure (31.0 +/- 7.9 mm Hg vs 25.5 +/- 7.0 mm Hg; p < 0.001) fell significantly and immediately after PTMV, there were no significant changes in the plasma ET-1 concentrations in the femoral vein, right atrium, left atrium, and femoral artery immediately after PTMV.. Increased production of ET-1 in the pulmonary circulation in response to increased pulmonary artery pressure was not the mechanism of increased circulating ET-1 concentration in patients with MS. We proposed that one of the mechanisms of increased ET-1 concentration in the femoral vein was increased peripheral ET-1 release due to increased systemic venous pressure and mechanical damage of the endothelium.

Topics: Adult; Age Factors; Aged; Analysis of Variance; Biomarkers; Case-Control Studies; Catheterization; Cohort Studies; Echocardiography, Doppler; Endothelin-1; Female; Follow-Up Studies; Hemodynamics; Humans; Logistic Models; Male; Middle Aged; Mitral Valve Stenosis; Postoperative Period; Preoperative Care; Probability; Reference Values; Rheumatic Heart Disease; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Treatment Outcome; Vascular Resistance

Increased plasma endothelin-1 concentrations have been observed in patients with rheumatic mitral stenosis. Endothelin-1 levels have never been investigated in patients with mitral stenosis and history of cerebral thromboembolism.. We measured plasma concentrations of endothelin-1 in the peripheral venous blood samples obtained from 20 patients with moderate to severe rheumatic mitral stenosis (16 with permanent atrial fibrillation and 4 with sinus rhythm). Six patients had history of thromboembolism. The remaining 14 patients did not have history of thromboembolism. Plasma endothelin-1 concentrations were measured using solid phase sandwich enzyme linked-immuno-sorbent assay.. The peripheral venous concentrations of endothelin-1 of the six patients with history of thromboembolism did not differ from the concentrations of the 14 patients without history of thromboembolism (2.40 +/- 1.39 pg/ml vs. 2.49 +/- 0.66 pg/ml, p = 0.9).. Although plasma endothelin-1 concentrations were increased in patients with mitral stenosis, plasma endothelin-1 concentrations were not further elevated in patients with mitral stenosis and history of thromboembolism.

Topics: Adult; Aged; Atrial Fibrillation; Endothelin-1; Female; Humans; Intracranial Embolism and Thrombosis; Male; Middle Aged; Mitral Valve Stenosis; Rheumatic Heart Disease