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Endothelial Dysfunction in Patients with Severe Mitral Regurgitation
Benedetta Porro1, Paola Songia2, Veronika A Myasoedova3
1Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy. benedetta.porro@ccfm.it.
Journal of Clinical Medicine
|June 20, 2019
Summary
Mitral valve prolapse (MVP) repair improves oxidative stress but not endothelial dysfunction. Further therapies targeting endothelial function are needed for MVP patients undergoing mitral valve repair.
Area of Science:
- Cardiovascular Biology
- Biochemistry
- Surgical Research
Background:
- Mitral valve prolapse (MVP) is a common cause of severe mitral regurgitation.
- MVP patients often exhibit altered antioxidant defenses and L-arginine metabolism.
- The causal relationship between MVP, oxidative stress, and endothelial dysfunction remains unclear.
Purpose of the Study:
- To investigate whether oxidative stress and endothelial dysfunction are consequences or driving factors of MVP.
- To evaluate the impact of mitral valve repair (MVRep) on these parameters.
Main Methods:
- Analysis of 45 MVP patients undergoing MVRep (pre- and 6-months post-surgery) and 29 controls.
- Quantification of glutathione redox state (GSSG/GSH), L-arginine metabolites, osteoprotegerin (OPG), and circulating endothelial microparticles (EMP).
- Utilized liquid chromatography-tandem mass spectrometry, ELISA, and flow cytometry.
Main Results:
- MVP patients showed a decreased GSSG/GSH ratio post-MVRep, indicating restored oxidative stress levels.
- Symmetric and asymmetric dimethylarginine levels remained unchanged post-surgery.
- Osteoprotegerin (OPG) levels significantly increased post-MVRep, while endothelial microparticles (EMP) remained elevated compared to controls.
- Endothelial dysfunction markers did not improve after mitral valve repair.
Conclusions:
- Mitral valve repair effectively restores oxidative stress in MVP patients.
- Endothelial dysfunction persists post-surgery, suggesting it may not be solely a consequence of MVP.
- Therapeutic strategies targeting endothelial function pre- and post-MVRep could enhance patient outcomes.
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