Letter to the Editor Rheumatic mitral valve stenosis is associated with impaired flow-mediated dilatation Abdullah Tekin a, ⁎ , Göknur Tekin a , Alpay Turan Sezgin a , Cem Hücran b , Osman Kızılkılıç b , Tansel Erol a , Haldun Müderrisoğlu a a Başkent University, Faculty of Medicine, Department of Cardiology, Adana, Turkey b Başkent University, Faculty of Medicine, Department of Radiology, Adana, Turkey Received 3 December 2006; accepted 2 January 2007 Available online 3 April 2007 Abstract It has been demonstrated that rheumatic mitral valve stenosis (RMVS) is associated with an increase in markers of endothelial dysfunction. It is not known whether this association indicates an impairment of flow-mediated dilatation (FMD) of the vascular endothelium. Thirty patients with RMVS and 30 healthy subjects were studied. FMD in patients with RMVS was significantly smaller than in healthy controls (11.9 ± 0.4% vs 15.4 ± 0.70%, p = 0.003). The absolute change in brachial artery diameter in patients with RMVS was also significantly smaller than in healthy subjects (0.42 ± 0.26 mm vs 0.64 ± 0.32 mm, p b 0.001). These findings suggest that vascular endothelial function is altered in patients with RMVS. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Vascular endothelium; Mitral stenosis; Flow-mediated dilatation Acute rheumatic fever is an immunologic disease, with inflammatory manifestations involving heart, joints and skin. Mitral stenosis is a late complication of acute rheumatic fever and there is a usually long interval between an episode of rheumatic carditis and clinical presentations of symptomatic mitral stenosis [1]. It has been suggested that activated valvular endothelium play a role in the initial development of rheumatic valvulitis and the progression of the disease throughout a lifetime [2]. Nevertheless, it was also shown that patients with rheumatic mitral valve stenosis (RMVS) have increased concentrations of cytokines such as von Willebrand factor [3], vascular cell adhesion molecule-1 [4–6], intercellular adhesion molecule-1 [4,5] and endothe- lin-1 [7–9] which, when elevated, are also markers of vascular endothelial dysfunction. Thus, we aimed to assess and compare vascular endothelial function in patients with RMVS by using the noninvasive, ultrasound guided technique which evaluates flow-mediated dilatation (FMD) of the brachial artery. We studied 30 patients with an echocardiographic diagnosis of RMVS and 30 age and gender matched healthy controls. Subjects with history of acute rheumatic fever less than 1 year, peripheral vascular disease, hypertension, diabetes mellitus, low high density lipoprotein cholesterol concentration (b 35 mg/dl), elevated low density lipoprotein cholesterol concentration (N 130 mg/dl), high triglyceride concentration (N 200 mg/dl), medications with angiotensin- converting enzyme inhibitors, oral contraceptive drugs, statins, vasoactive drugs and vitamin supplements, a family history of premature coronary artery disease, rhythm other than sinus, history of smoking, cardiomyopathies, vasculitis, recent surgery, history of embolism, pulmonary and hema- tologic disorders were excluded from the study. Subject with moderate or severe mitral, tricuspid or aortic regurgitation were also excluded from the study. Since FMD of the brachial artery fluctuates across the phases of menstrual cycle, all ultrasonic examinations on females were performed during International Journal of Cardiology 125 (2008) 410 – 412 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Başkent University, Faculty of Medicine, Department of Cardiology, Dadaloğlu Mahallesi, 39. Sok. No. 6, 01250, Yüreğir/Adana,Turkey. Tel.: +90 322 231 07 91; fax: +90 322 327 12 76. E-mail address: tekincardio@yahoo.com (A. Tekin). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.01.048