Evaluation of left atrial mechanical function and atrial conduction abnormalities in Maras powder (smokeless tobacco) users and smokers.

OBJECTIVE: In Turkey, a type of smokeless tobacco called Maras powder (MP) is widely used in the south-eastern region. Smokeless tobacco is found in preparations for chewing and for absorption by the nasal and oral mucosae. The purpose of this study was to investigate whether MP damages intra- and inter-atrial conduction delay and left atrial (LA) mechanical function as much as cigarette smoking. METHOD: A total of 150 chronic MP users (50 males, 32.5 ± 5.4 years), smokers (50 males, 32.1 ± 6.0 years) and controls (50 males, 30.1 ± 5.8 years) were included in the study. LA volumes were measured echocardiographically according to the biplane area-length method. Atrial electromechanical coupling was measured with tissue Doppler imaging and LA mechanical function parameters were calculated. RESULTS: The LA passive emptying fraction was significantly decreased and LA active emptying volume (LAAEV) was significantly increased in the MP group (p = 0.012 and p = 0.024, respectively), and the LA active emptying fraction (LAAEF) was significantly increased in the smokers (p = 0.003). There was a positive correlation between the amount of MP used and smoking (pack years) with LAAEV and LAAEF (r = 0.26, p = 0.009 and r = 0.25, p = 0.013, respectively). Lateral atrial electromechanical intervals (PA) were significantly higher in MP users, and the septal mitral PA was statistically higher in the smokers (p = 0.05 and p = 0.04, respectively). CONCLUSION: We suggest that atrial electromechanical coupling intervals were prolonged and LA mechanical function was impaired in MP users and smokers, but there was no significant difference between the MP users and smokers. These findings may be markers of subclinical cardiac involvement and tendency for atrial fibrillation.

Evaluation of atrial electromechanical delay and its relationship to inflammation and oxidative stress in patients with chronic obstructive pulmonary disease.

OBJECTIVES: The aims of this study were to evaluate atrial electromechanical delay, inflammation, and oxidative stress parameters, along with to investigate clinical and laboratory characteristics affecting atrial electromechanical delay in patients with chronic obstructive pulmonary disease (COPD). METHODS: Forty-three patients with COPD (60.5 ± 9.9 years) and 50 healthy controls (59.6 ± 7.1 years) were included in the study. Atrial electromechanical delay intervals were measured from lateral mitral annulus corrected PA (cPA lateral) and lateral tricuspid annulus (cPA tricuspid) using tissue Doppler imaging (TDI), and corrected for heart rate. Left and right ventricles functions were examined using conventional and TDI. Plasma levels of high-sensitive C-reactive protein (hsCRP) and oxidative stress parameters were also measured. Factors associated with atrial electromechanical delay were evaluated by stepwise multiple regression analysis. RESULTS: Corrected PA lateral and cPA tricuspid were significantly higher in patients with COPD (69.8 ± 10.4 vs. 62.2 ± 8.9 msec, P < 0.001 and 45.4 ± 10.2 vs. 33.5 ± 5.1 msec, P < 0.001, respectively). Plasma levels of hsCRP and malondialdehyde, an indicator of oxidative stress, were increased in patient's group (15.7 ± 31.7 vs. 4.8 ± 4.7 mg/L, P = 0.01 and 17.1 ± 10.3 vs. 11.6 ± 7.9 nmol/L, P = 0.005, respectively). cPA lateral is independently related to lateral Em /Am ratio (ß = -0.29, P = 0.004) and forced expiratory volume in 1st second/forced vital capacity (FEV1 /FVC) ratio (ß = -0.24, P = 0.02). cPA tricuspid is independently related to only FEV1 /FVC ratio (ß = -0.51, P < 0.001). CONCLUSIONS: This study shows that atrial electromechanical delay intervals are prolonged in patients with COPD. Prolongation of atrial electromechanical delay measured from lateral tricuspid annulus was independently related with FEV1 /FVC ratio in these patients.

Aortic intracardiac echocardiography-guided septal puncture during mitral valvuloplasty.

AIMS: Transoesophageal echocardiography (TEE) and venous intracardiac echocardiography (ICE) are traditionally used to visualize the interatrial septum (IAS) and the tenting effect of the fossa ovalis in patients undergoing percutaneous balloon mitral valvuloplasty (PBMV). The aim of the present study was to assess the comparative efficacy and safety of arterial (intra-aortic) ICE and venous ICE, compared with TEE (traditional approach), in the patients undergoing PBMV. METHODS AND RESULTS: TEE, aortic ICE, and venous ICE were consecutively performed in 50 patients (40 ± 9 years, 86% female). The images of intracardiac structures were obtained from both aortic and right atrial loci. The IAS was visualized using TEE, aortic ICE, and venous ICE. The mean mitral valve area was 1.14 ± 0.2 cm(2), and the mean left atrial volume index was 57.5 ± 12 mL/m(2). The mean size of the visualized septal length was 48 ± 5 mm by TEE, 51 ± 5 mm by aortic ICE, and 33 ± 6 mm by venous ICE. The Bland-Altman test indicated that the 95% limits of agreement for the measurement of septal diameter ranged from -11.0 to +5.9 mm (mean -2.5 mm) between TEE and aortic ICE, -2.8 to +33.5 mm (mean +15.3 mm) between TEE and venous ICE, and -36.6 to +0.8 mm (mean -17.9 mm) between venous and aortic ICE. Standard venous ICE generally tended to yield smaller values compared with TEE and aortic ICE for the measurement of septal length. Furthermore, the view of fossa ovalis and 'tenting effect' was optimal in 11 patients on venous ICE; however, the fossa ovalis and tip of the needle were well visualized in all patients on aortic ICE (P < 0.001). There were no major complications with the use of aortic ICE. CONCLUSION: Aortic ICE is a superior alternative to venous ICE and facilitates trans-septal puncture in patients with mitral stenosis.

Spontaneous coronary artery dissection in a healthy adolescent following consumption of caffeinated "energy drinks".

Spontaneous coronary artery dissection (SCAD) is a rare and uncommon case of sudden cardiac death and acute coronary syndrome. Herein, we present a 13-year-old boy with chest pain who was diagnosed with acute ST-segment elevation myocardial infarction associated with SCAD, possibly caused by the consumption of an energy drink, which has not been reported previously in the pediatric age group. On coronary angiography, the left anterior descending artery showed extensive dissection from the distal part of the vessel. Based on the morphology of the vessel with a dissection and TIMI flow grade III, it was decided to manage this patient conservatively with close follow-up. The aim of this report is to highlight the risks associated with the consumption of caffeinated energy drinks in children.

Cardiac effects of chronic graft-versus-host disease after stem cell transplantation.

Chronic graft-versus-host disease (GVHD) develops as a result of the immunologic response that donor T-lymphocytes generate against host tissue after allogeneic stem cell transplantation. We tried to elucidate the contribution of cardiac dysfunction to the high morbidity and mortality rates observed after GVHD. Forty patients who had undergone bone marrow transplantation were enrolled in this prospective study: 14 patients who had been diagnosed with chronic GVHD (manifestations beyond day 100 after hemopoietic cell transplantation) and 26 patients who had not. All patients had undergone baseline echocardiography before bone marrow transplantation and were monitored. After the expected period of time had elapsed for GVHD after transplantation, these patients were divided into 2 groups in accordance with whether or not they developed chronic GVHD. No significant differences were observed before bone marrow transplantation in the 2 groups' broad attributes or in their laboratory and echocardiographic findings (P >0.05). After transplantation, high-sensitivity C-reactive protein levels and erythrocyte sedimentation rates were significantly higher in the chronic GVHD group (P < 0.001 and P=0.01, respectively). Mean left ventricular mass was 227 ± 32.3 g in the GVHD group and 149.3 ± 27.4 g in the non-GVHD group (P < 0.001). The E/A flow rate was significantly higher in the non-GVHD group. This study shows that chronic GVHD increases left ventricular mass and impairs left ventricular diastolic function in patients who have developed chronic GVHD. In addition, it shows that inflammatory markers increase to higher levels in these patients. Comprehensive studies with larger samples are needed to more fully elucidate the cardiac effects of this disease.

Abnormal heart rate recovery on exercise in ankylosing spondylitis.

OBJECTIVES: This study evaluated the heart rate recovery response in ankylosing spondylitis (AS) patients and control subjects. BACKGROUND: Delayed heart rate recovery after exercise reflects AD and independently predicts adverse cardiac outcome. METHODS: Fifty-one patients with AS and 50 age- and matched controls received electrocardiography, echocardiography, and treadmill exercise testing. The heart rate recovery (HRR) index was calculated as the reduction in heart rate from the rate at peak exercise to the rate at the 1st (HRR1), 2nd (HRR2), 3rd (HRR3) and 5th (HRR5) minute after the cessation of exercise stress testing. RESULTS: There were significant differences in HRR1 and HRR2 indices between patients and controls (24.8 ± 12.1 vs 34.9 ± 11.0; p<0.001 and 41.2 ± 14.2 vs 54.3 ± 11.8; p<0.001, beats/min, respectively). Similarly, HRR3 and HRR5 indices were lower in patients than controls (51.3 ± 15.1 vs 65.2 ± 14.0; p<0.001 and 61.0 ± 14.2 vs 76.1 ± 14.8; p<0.001). In addition, exercise capacity was markedly lower (8.1 ± 2.0 vs 10.5 ± 2.5 METs; p<0.001) in AS than controls. CONCLUSION: The HRR index is impaired in AS patients, implying the occurrence of autonomic dysfunction even without active joint disease or frank cardiac involvement.

Relation of epicardial fat thickness with carotid intima-media thickness in patients with type 2 diabetes mellitus.

Aims. The aim of this study was to investigate the relationship of echocardiographic epicardial fat thickness (EFT) with carotid intima-media thickness (CIMT), in patients with type 2 diabetes mellitus (T2DM). Methods and Results. A total of 139 patients with T2DM (mean age 54.3 ± 9.2 and 49.6% male) and 40 age and sex-matched control subjects were evaluated. Echocardiographic EFT and ultrasonographic CIMT were measured in all subjects. Patients with T2DM had significantly increased EFT and CIMT than those of the controls (6.0 ± 1.5 mm versus 4.42 ± 1.0 mm, P < 0.001 and 0.76 ± 0.17 mm versus 0.57 ± 0.14 mm, P < 0.001, resp.). EFT was correlated with CIMT, waist circumference, BMI, age, duration of T2DM, HbA1c in the type 2 diabetic patients. Linear regression analysis showed that CIMT (ß = 3.52, t = 3.72, P < 0.001) and waist circumference (ß = 0.36, t = 2.26, P = 0.03) were found to be independent predictors of EFT. A cutoff high risk EFT value of 6.3 mm showed a sensitivity and specificity of 72.5% and 71.7%, respectively, for the prediction of subclinical atherosclerosis. Conclusion. We found that echocardiographic EFT was significantly higher in patients with T2DM. Our study also showed that EFT was strongly correlated with waist circumference and CIMT as being independent of sex.

Protective effects of nebivolol against anthracycline-induced cardiomyopathy: a randomized control study.

BACKGROUND: We aimed to evaluate the effect of prophylactic nebivolol use on prevention of antracycline-induced cardiotoxicity in breast cancer patients. METHODS: In this small, prospective, double-blind study, we randomly assigned 45 consecutive patients with breast cancer and planned chemotheraphy to receive nebivolol 5mg daily (n=27) or placebo (n=18). Echocardiographic measurements and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels were obtained at baseline and at 6-month of chemotherapy. RESULTS: Both studied groups had comparable echocardiographic variables and NT-pro-BNP levels at baseline. At 6-month, the left ventricular (LV) end-systolic and end-diastolic diameters increased in the placebo group (LVESD: 29.7 ± 3.4 to 33.4 ± 4.5mm; LVEDD: 47.2 ± 3.8 to 52.0 ± 4.6mm, p=0.01 for both) but remained unchanged in the nebivolol group (LVESD: 30.4 ± 3.5 to 31.0 ± 3.6mm, p=0.20; LVEDD: 47.0 ± 4.4 to 47.1 ± 4.0mm, p=0.93). The placebo group also had lower LVEF than the nebivolol group (57.5 ± 5.6% vs. 63.8 ± 3.9%, p=0.01) at 6-month. NT-pro-BNP level remained static in the nebivolol group (147 ± 57 to 152 ± 69 pmol/l, p=0.77) while it increased in the placebo group (144 ± 66 to 204 ± 73 pmol/l, p=0.01). CONCLUSIONS: Prophylactic use of nebivolol treatment may protect the myocardium against antracycline-induced cardiotoxicity in breast cancer patients.

Effects of serum uric acid levels on coronary collateral circulation in patients with non-ST elevation acute coronary syndrome.

OBJECTIVES: The strong relationship between high level of serum uric acid (UA) and cardiovascular disease has been shown in many studies. In this study, we investigated whether serum UA levels affect coronary collateral circulation (CCC) in patients with non-ST elevation acute coronary syndrome. METHODS: The study population included 175 patients with non-ST elevation acute coronary syndrome. On the first day of admission to the hospital, blood samples were taken and UA levels were analyzed for all patients. Coronary angiography was performed on patients within 24-72 h. Rentrop collateral classification was performed. Patients were divided into two groups on the basis of UA levels: group I consisted of 102 patients (90 male, 12 female) with normal UA levels and group II consisted of 73 patients (59 male, 14 female) with elevated UA levels. RESULTS: Group 2 had a significantly higher rate of poorly developed CCC and a lower rate of well-developed CCC compared with group 1 (P=0.003 and 0.001, respectively). Patients with poor CCC had significantly higher serum UA levels compared with patients with well-developed CCC (6.5±1.1 vs. 5.5±1.7 mg/dl, P=0.028). Linear regression analyses showed that poor CCC development was significantly associated with serum UA levels (coefficient=0.22, P=0.005). CONCLUSION: Serum UA level on admission is associated with poor CCC development and may be a useful biomarker for stratification of risk in patients with non-ST elevation acute coronary syndrome.

Myocardial bridging of the left anterior descending coronary artery and right coronary artery in a patient with mitral valve stenosis.

Myocardial bridging is defined as the intramural course of a major epicardial coronary artery, and is mostly confined to the left ventricle and the left anterior descending coronary artery (LAD). Although it is considered to be a benign anomaly, it can lead to such complications as acute myocardial infarction, ventricular tachycardia, syncope, atrioventricular block and sudden cardiac death. Isolated myocardial bridging of the right coronary artery (RCA) and left circumflex artery have been reported in the literature In our case, myocardial bridging was observed in both the LAD and the RCA in a patient with mitral valve stenosis.

The effects of significant coronary stenosis and percutaneous coronary intervention on aortic stiffness.

OBJECTIVES: Although aortic stiffness (AS) is a strong predictor of cardiovascular events, its value is unknown in patients who have coronary stenosis and undergo percutaneous coronary intervention (PCI). Our hypothesis was that AS might provide additional information about coronary hemodynamic status. In this context, we investigated the effects of coronary stenosis and PCI on AS. STUDY DESIGN: The study included 107 patients undergoing coronary angiography. The patients were divided into three groups based on the angiographic results: 39 patients with significant lesions (≥50%) formed the 'critical group' and 38 patients with nonsignificant lesions (<50%) formed the 'noncritical group'. The control group (30 patients) had normal angiograms. Aortic stiffness was determined using the carotid-femoral aortic pulse wave velocity (PWV) method. All patients in the critical group underwent successful PCI and repeat PWV measurements. RESULTS: All baseline characteristics were similar in the three groups except for the mean PWV, which was significantly higher (9.4±2.2 m/sec) in the critical group compared to the control group (5.7±1.1 m/sec) and the noncritical group (5.8±1.1 m/sec) (p<0.0001). The latter two groups had similar PWV values (p=0.6). After PCI, the mean PWV decreased significantly by 24.4% to 7.1±2.0 m/sec (p=0.002); however, it was still significantly higher than that of the control group (p<0.0001). In correlation analysis, PWV showed significant correlations with age (r=0.412, p=0.01), systolic blood pressure (r=0.342, p<0.01), and hemoglobin (r=-0.370, p=0.02). Multiple logistic regression analysis showed that PWV was a predictor for significant stenosis [Exp(B) 3.960, 95% CI 2.014-7.786]. CONCLUSION: Our findings suggest that significant coronary stenosis is associated with significantly increased AS and successful PCI improves AS to some extent.

Relationship between psychosocial status, diabetes mellitus, and left ventricular systolic function in patients with stable multivessel coronary artery disease.

BACKGROUND: Negative emotional conditions contribute to the development of coronary artery disease (CAD). Depression and anxiety are prognostic factors in patients with CAD. The aim of our study was to investigate the association between emotional conditions and left ventricular (LV) systolic functions in CAD. METHODS: 168 patients (102 men, 66 women, mean age 66.3 ± 9.9 years) with stable angina and multivessel disease (MVD) were included in the study. According to the LV ejection fraction (LVEF) in echocardiography, patients were divided into two groups, the preserved group (LVEF > 50%), and the impaired group (LVEF < 50%). The preserved group consisted of 94 patients and the impaired group consisted of 74 patients. Emotional status was evaluated using the Hamilton Depression (HAM-D), Hamilton Anxiety (HAM-A), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores. RESULTS: The prevalence of diabetes mellitus (DM) was significantly higher in the impaired group than in the preserved group (29.8% vs 56.8%, p < 0.01). The HAM-D, HAM-A, BAI and BDI scores were higher in the impaired group compared to the preserved group (HAM-D: 12.1 ± 3.3 vs 14.5 ± 2.3, p = 0.03; HAM-A: 12.7 ± 3.4 vs 14.3 ± 2.2, p = 0.01; BAI: 18.6 ± ± 6.4 vs 22.1 ± 6.6, p = 0.01 and BDI: 13.9 ± 2.5 vs 17.2 ± 2.0, p = 0.002, respectively). In multivariate analysis, BDI scores (odds ratio [OR]: 2.197, < 95% confidence interval [CI] 1.101-4.387; p = 0.026), HAM-A scores (OR: 1.912, < 95% Cl 1.092-2.974; p = 0.041) and DM (OR: 2.610, < 95% Cl 1.313-5.183; p = 0.006) were important risk factors for LV dysfunction in stable patients with MVD. CONCLUSIONS: This study demonstrated that emotional status and DM are factors associated with impaired LV systolic function in patients with stable CAD.

Assessment of aortic elastic properties in patients with sarcoidosis.

BACKGROUND: Sarcoidosis is an inflammatory granulomatous disease of unknown etiology that involves multiple organ systems. Many studies have shown a strong relationship between inflammation and atherosclerosis. The aim of this study is to investigate the relationship between elastic properties of the aorta and the duration of the disease in patients with sarcoidosis. METHOD: The study population included 52 patients with sarcoidosis (22 men, mean age = 42.7 ± 10.7 years, and mean disease duration = 38.8 ± 10.8 months) and 50 healthy control subjects (18 men, and mean age = 42.0 ± 8.0 years). Aortic stiffness (ß) index, aortic strain (AoS) and aortic distensibility (AoD) were calculated from the aortic diameters measured by transthoracic echocardiography and blood pressure obtained by sphygmomanometer. Cardiac functions were determined by using routine echocardiographic evaluation consist of standard two-dimensional and conventional Doppler and tissue Doppler imaging. RESULTS: The conventional echocardiographic parameters were similar between patients and controls. There were significant differences between the control and the patient groups in ß index (1.63 ± 0.55 vs 2.44 ± 1.54, p = 0.001), AoS (15.61 ± 5.69 vs 10.93 ± 4.11%, p < 0.001) and AoD (6.35 ± 2.64 vs 4.66 ± 1.98, 10 (-6) cm(2)/dyn, p = 0.001). There were statistically significant negative correlations between the disease duration and AoD (r = -0.46, p = 0.01) and AoS (r= -0.44, p = 0.002), whereas there was a positive correlation between the disease duration and ß index (r = 0.37, p = 0.01). In multivariate analysis, disease duration was significantly related with AoD, AoS and ß index (respectively, RR = 3.28, p = 0.002; RR = 3.03, p = 0.004; RR = 2.39, p = 0.02). CONCLUSION: We observed that elastic properties of the aorta alter in patients with sarcoidosis. We also have demonstrated a statistically significant correlation between aortic elastic properties and the disease duration.

Dose-dependent acute effects of passive smoking on left ventricular cardiac functions in healthy volunteers.

OBJECTIVE: We have previously shown that acute passive smoking impaired left ventricular diastolic function in healthy volunteers. The aim of this study was to determine whether length of exposure and/or ambient smoke concentration is the key determinant of this outcome. METHODS: We measured blood carboxyhemoglobin (COHb)and lactate level to investigate the acute effects of passive smoking on tissue oxygenation. A total of 90 healthy nonsmoker volunteers were prospectively enrolled into the study. Each of 30 subjects were exposed to carbon monoxide (CO) less than 5.0 ppm smoke in group A for 30 minutes, to CO 5 to 10 ppm smoke in group B for 30 minutes, and to CO less than 5.0 ppm smoke in group C for 60 minutes. Hemodynamic parameters were obtained, blood samples for measuring COHb and lactate levels were taken and echocardiographic examinations were performed at baseline and after exposure to passive smoking. RESULTS: Mean ± SD CO levels in groups A, B, and C were 4.2 ± 0.5 ppm, 9.2 ± 0.3 ppm, and 4.1 ± 0.8 ppm, respectively. There was no change in left ventricular systolic functions in all groups. Left ventricular diastolic functions were impaired in groups B and C, whereas no change was observed in group A. Carboxyhemoglobin and lactate levels increased after passive smoking in groups B and C. However, group B had significantly higher COHb and lactate levels compared to group C (P < 0.001). CONCLUSIONS: Our results suggested that passive smoking at a certain dose in relation with length of exposure and ambient smoke concentration seems to cause relative left ventricular diastolic dysfunction.

The prognostic value of serum gamma glutamyl transferase activity on admission in patients with STEMI undergoing primary PCI.

We assessed the association between serum gamma glutamyl transferase (GGT) activity with postprimary percutaneous coronary intervention (PCI) coronary flow and in-hospital major advanced cardiac events (MACEs) in patients with ST elevation myocardial infarction (STEMI). Patients with STEMI (n = 425; males 78%; mean age 60 ± 13 years) were enrolled. Patients were divided into 3 GGT tertiles and 2 groups according to thrombolysis in myocardial infarction (TIMI) flow grade. The TIMI flow percentages were similar in the 3 GGT tertiles (32%, 45%, and 42%, respectively, P = .336). Total MACE increased with GGT tertiles (among tertiles, respectively; P < .001). The total MACE was significantly higher in impaired flow group than in normal flow group (23% vs 7%; P < .001). At multivariate analyses, serum GGT activity was an independent predictor of in-hospital MACE (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01-1.33; P < .001). In conclusion, serum GGT activity is associated with in-hospital MACE in patients with STEMI undergoing primary PCI.

Hematologic parameters and angiographic progression of coronary atherosclerosis.

Hematologic parameters have prognostic importance in cardiovascular disease. However, the relation between atherosclerosis progression and hematologic parameters is not well defined. A total of 394 patients requiring repeat coronary angiography were included in the study. According to angiography, patients were divided into 2 groups, progressive (n = 196) and nonprogressive (n = 198) diseases. Hematologic parameters including mean platelet volume (MPV) and neutrophil/lymphocyte (N/L) ratio were measured. Glucose, creatinine, and cholesterol were significantly higher in the progressive group. Mean platelet volume count was similar in both groups. The N/L ratio was significantly higher in the progressive group (5.0 ± 5.1 vs 3.2 ± 3; P = .001). In multivariate analysis, the N/L ratio was significantly related with progression (relative risk [RR]: 2.267, 95% CI: 1.068-4.815, P = .03). Progression rate was significantly high in patients with high N/L ratio (39% vs 56%). Our results suggest that the N/L ratio is a predictor of progression of atherosclerosis.

Brucella glomerulonephritis and prosthetic valve endocarditis: a case report.

Although brucellosis is an endemic disease in Mediterranean countries, there are few reported cases of Brucella endocarditis and glomerulonephritis. We report a case of Brucella prosthetic mitral valve endocarditis and glomerulonephritis that could be managed by using only antibiotic therapy, including rifampicin, doxycycline and ceftriaxone, without a surgical procedure.

Relation of left atrial spontaneous echocardiographic contrast in patients with mitral stenosis to inflammatory markers.

Spontaneous echocardiographic contrast (SEC) is the presence of smoke-like echoes with a characteristic swirling motion of blood in echocardiography. Previous clinical studies have demonstrated that SEC is a risk factor for left atrial thrombus formation and an important indicator of potential systemic embolism originated from heart. An established relation exists between the inflammatory status and the prothrombotic state. Therefore, we investigated the role of inflammatory status on SEC in patients with mitral stenosis (MS). A total of 62 consecutive patients with MS who undergoing mitral balloon valvuloplasty were enrolled in the present study. The patients were divided into 2 groups according to the formation of SEC in the left atrium. Of the 62 patients, 32 (mean age 45 ± 12 years; 75% women) were in the SEC-negative group and 30 patients (mean age 45 ± 11 years; 63% women) were in the SEC-positive group. The high-sensitive C-reactive protein levels were significantly greater in the SEC-positive group than in the SEC-negative group (3.9 ± 2.2 vs 10.6 ± 6.3, p = 0.024). The neutrophil levels (64.6 ± 9.4 vs 72.6 ± 8.6) were significantly greater in the SEC-positive group, and the lymphocyte levels (24.4 ± 6.9 vs 18.3 ± 6.0) were significantly greater in the SEC-negative group (p = 0.001 for each). The neutrophil/lymphocyte (N/L) ratio was also significantly greater in the SEC-positive group (3.0 ± 1.8 vs 4.5 ± 1.8, p = 0.003). In the receiver operating characteristics curve analysis, a N/L ratio > 3.1 mg/dl had a 80% sensitivity and 72% specificity in predicting SEC in patients with MS. On multivariate analysis, high-sensitive C-reactive protein (odds ratio [OR] 1.235, 95% confidence interval [CI] 1.040 to 1.466; p = 0.016), N/L ratio (OR 1.461, 95% CI 0.977 to 2.184; p = 0.02), left atrial volume (OR 3.012, 95% CI 1.501 to 5.611; p = 0.001), and mitral valve area (OR 0.135, 95% CI 0.020 to 0.503; p = 0.017) were independent risk factors of SEC in patients with MS. In conclusion, the high-sensitive C-reactive protein and N/L ratio were independently associated with SEC in patients with MS.