The association between severe rheumatic mitral stenosis (SRMS) and high level of thromboembolic event are well known. Activated platelets stimulate thrombus formation in response to rupture of atherosclerotic plaques or endothelial cell erosion, promoting atherothrombotic disease. The platelet-lymphocyte ratio (PLR) is a novel inflammatory marker, which may be used in many diseases for predicting thromboembolic event. A high PLR reflects inflammation, atherosclerosis and platelet activation. Although, PLR is a potential prognostic marker in a number of different diseases, However, the impact of percutaneous transmitral valvuloplasty (PTMV) on PLR has never been studied. The aim of this study was to evaluate the prognostic impact of the PLR before and one month after PTMV procedure in patients with SRMS.

We investigated retrospectively data of consecutive 88 patients(71 women and 17 men) with SRMS treated with PTMV between September 2013 and April 2015 in referee centre. All subjects were evaluated with a detailed medical history and physical examination. 18 patients were excluded in this study because of some condition to be changed to PLR levels, 16 patients with normal sinus rhythm were excluded. 3 patients were also excluded due to failure PTMV. PLR was measured in patients with SRMS before and one month after the procedure.

Before and one month after PTMV, mitral valve area (MVA), transmitral gradient (TMG), left atrium diameter (LAD) and estimates systolic pulmonary artery pressure (esPAP) were measured using transthoracic echocardiography (TTE).

Fifty one patients with SRMS were included in this study. In patients with SRMS (mean age: 43±27 years, and 46 (%90.2) were women), MVA was increased significantly after PTMV compare with before procedure (1.1±0.18 and 1.83±0.21 respectively p < 0.001), LAD(46.7.2±0.79 and 42.47±0.48), TMG and esPAP (52 ±14.15 and 36.6±8.1 respectively p < 0.001) were significantly decreased after PTMV compare with before procedure. NYHA functional capacity(2.43±0.5 and 1.33±0.47 p=0.004) and six minute walk test (262.2±57.4 and 455.8±70.5 respectively p < 0.001) were importantly increased one month after procedure. PLR levels were decreased one month after PTMV procedure(142.9±58.9 and 125±45 p < 0.020).

Platelet-lymphocyte ratio can be an easy and accessible marker and predictor of trombeembolic events in patients with rheumatic mitral stenosis. Current evidence shows that a high PLR reflects inflammation and platelet activation. The PLR can be easily calculated and is widely available. More research is needed to determine how the PLR may be used in patients with rheumatic mitral stenosis.