Effect of Colchicine on Left Atrial Mechanics in Rheumatic Heart Disease: The COL-RHD A Pilot Trial

Rheumatic heart disease is increasingly recognized as an immunologically active condition characterized by persistent low-grade inflammation contributing to atrial dysfunction.

The authors aimed to evaluate whether colchicine reduces systemic inflammation and improves left atrial (LA) mechanical function in chronic rheumatic mitral valve disease.

In this prospective, double-blind, randomized controlled trial, 90 patients with chronic moderate-to-severe rheumatic mitral valve disease were randomized (1:1) to colchicine (0.5 mg twice daily) or placebo for 6 months in addition to standard therapy. The primary outcome was change in interleukin (IL)-6 at 6 months. Secondary outcomes included changes in other inflammatory markers, LA strain parameters, NYHA functional class, and correlations between inflammatory markers and LA mechanics.

Colchicine significantly reduced inflammatory markers (IL-6, high-sensitivity C-reactive protein, erythrocyte sedimentation rate; all P < 0.001). IL-6 decreased from 98.0 (86.9-112.1) to 11.2 (7.3-21.5) pg/mL in the colchicine group, while increasing in placebo (P < 0.001). LA reservoir strain improved significantly (23.6% ± 2.0% vs 16.5% ± 1.6%, P < 0.001). IL-6 showed strong inverse correlation with LA reservoir strain (r = -0.65, P < 0.001). Functional status improved, with 69.2% of NYHA functional class III patients improving to class II.

Colchicine significantly attenuates systemic inflammation and improves LA mechanical function and functional status in chronic rheumatic mitral valve disease, supporting an inflammation-driven atrial myopathy phenotype.