The role of systemic immune inflammatory index in the development of atrial fibrillation in rheumatic mitral stenosis disease

ABSTRACT: The Role of Systemic Immune Inflammatory Index in the Development of Atrial Fibrillation in Rheumatic Mitral Stenosis Disease Objective: Atrial fibrillation and its complications constitute a significant cause of morbidity and mortality in the community. Rheumatic heart disease is a noteworthy health concern in developing countries and among refugee populations. This study investigates the relationship between novel inflammatory markers, namely Platelet Lymphocyte Ratio (PLR), Neutrophil Lymphocyte Ratio (NLR), Systemic Immune Inflammation Index (SII), and atrial fibrillation in Rheumatic Mitral Disease. Materials and Methods: Over the course of the last decade, a total of 97 patients diagnosed with Rheumatic Heart Disease and exhibiting a mitral valve area below 1.5 cm², as confirmed by echocardiography, were enrolled in this study. Comprehensive data, including Electrocardiogram (ECG), echocardiographic parameters, complete blood count, and biochemical profiles, were meticulously documented upon admission. Subsequently, all collected data underwent thorough evaluation through appropriate statistical analyses. Results:The advanced age, left atrial diameter, aortic root dimension, mitral valve stenosis, tricuspid regurgitation, creatinine, AST, ALT, platelet count, Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR), and Systemic Immune-Inflammatory Index (SII) values were found to be significantly elevated in patients with atrial fibrillation (AF) compared to those without, while High-Density Lipoprotein (HDL) levels were lower. The sensitivity of SII in the diagnostic assessment of AF, as evaluated by Receiver Operating Characteristic (ROC) analysis, yielded an area under the curve of 66% of the total area, with a sensitivity of 55.56%, specificity of 83.72%, and an AF cutoff value of 742514.38 (p=0.005). According to univariate analyses, age (OR: 1.08, p<0.001), left atrium (LA) size (OR: 1.23, p<0.001), mitral valve area (OR: 0.08, p=0.017), tricuspid regurgitation (OR: 4.5, p=0.032), SII (OR: 1.01, p=0.024), and aortic root dimension (OR: 1.13, p=0.034) were identified as significant factors in determining the risk of AF. However, according to multivariate analyses, only LA (OR: 1.2, p=0.013) and SII (OR: 1.01, p=0.010) were found to have a significant impact, while the effects of other variables were not significant (p>0.05 for each) Conclusion: The use of the Systemic Immune-Inflammation Index (SII) proves to be a convenient and cost-effective approach for atrial fibrillation screening in patients with moderate to severe mitral stenosis due to rheumatic heart disease. Future studies are warranted to advance the development of atrial fibrillation screening algorithms specific to rheumatic heart disease. Keywords: Rheumatic Heart Disease, Rheumatic Mitral Stenosis, Atrial Fibrillation, Inflammation, SII, Biomarker