Background: Spontaneous echocardiographic contrast (SEC) is a risk factor for left atrial thrombus formation and an important indicator of potential systemic embolism originated from heart. An established relation exists between the inflammatory status and the prothrombotic state. The present study was conducted to evaluate the association between left atrial spontaneous echocardiographic contrast with inflammatory markers in mitral stenosis patients. Methods: This observational analytical study was undertaken in the department of Cardiology, National Institute of Cardiovascular diseases (NICVD), Dhaka. A total of 70 patients with mitral stenosis were categorized into two groups: group I with left atrial SEC and group II without left atrial SEC. All patients underwent transthoracic as well as transoesophageal echocardiography. Complete blood count with ESR was done and neutrophil lymphocyte ratio was calculated. The high sensitive C-reactive protein (hs-CRP) was assayed. Results: The hs-CRP levels were significantly greater in the SEC-positive group (5.6±2.1vs 1.5±0.7, p=0.001). The mean ESR level was significantly greater in the SEC-positive group (32.6±15.5 mmvs15.8±4.7 mm).The neutrophil levels ((76.1±1.9 vs 63.7±3.3) were significantly greater in the SEC-positive group, and the lymphocyte levels (33.3±3.0 vs 21.5±1.3) were significantly greater in the SEC-negative group (p=0.001 for each). The neutrophil/lymphocyte (N/L) ratio was also significantly greater in the SEC-positive group (3.4±0.4 vs2.1±0.6, p=0.001).On multivariate analysis hs-CRP, neutrophil/lymphocyte ratio, raised ESR, mitral valve area and left atrial diameter were independent risk factors for SEC in patients with mitral stenosis. Conclusion: From this study it may be concluded that left atrial SEC is associated with raised inflammatory markers in majority of patients with mitral stenosis. So, SEC may be considered as a reflection of ongoing inflammatory process in patients with mitral stenosis. DOI: http://dx.doi.org/10.3329/cardio.v7i1.20797 Cardiovasc. j. 2014; 7(1): 24-30

Introduction:Cardiovascular diseases (CVD) are the number one cause of death globally. An estimated 17.3 million people died from CVDs in 2008, representing 30% of all global deaths. Of these deaths, an estimated 7.3 million were due to coronary heart disease. The number of people who die from CVDs will increase to reach 23.3 million by 2030. Coronary artery disease (CAD) is the most common cause of CVD mortality. 1 Cardiovascular diseases are becoming a significant burden on health care services in Bangladesh. 2 With the increase incidence of DM and hypertension, the prevalence of CKD is also alarmingly going up. CKD is strongly associated with accelerated CVDs and this association is independent of conventional risk factors such as DM, hypertension, dyslpidaemia 3 and caused by non-conventional risk factors such as anaemia, altered calcium-phosphorus metabolism, increased homocysteine level, inflammation and oxidative stress. 4 The glomerular filtration rate (GFR), determined by the Cockcroft-Gault equation, is a more precise and accurate way of estimating kidney function than measuring serum creatinine. 5 The United States National Kidney Foundation uses GFR rather than serum creatinine level to define renal dysfunction. National Kidney Foundation recommended estimated GFR for use in recognition, treatment and prevention of chronic kidney disease. It is considered as the overall best indicator of kidney function. Serum creatinine alone fails to identify many patients whose kidney function is reduced.