Effect of Percutaneous Mitral Balloon Commissurotomy on Sympatho-vagal Balance in Patients with Mitral Stenosis: A Prospective Cohort Study.

Abstract

Introduction: Mitral stenosis (MS) remains a significant cardiovascular burden, particularly in developing nations, where rheumatic heart disease is a major contributor. Percutaneous mitral balloon commissurotomy (PMBC) is a widely used intervention to improve hemodynamic and alleviate symptoms in MS patients.

Methods: A prospective cohort study was carried out on 40 patients with mitral stenosis (MS) who underwent percutaneous mitral balloon commissurotomy (PMBC). Heart rate variability (HRV) was recorded before the procedure and two weeks after, using 5-minute short-term analysis. The assessment included time-domain measures [average heart rate (HR), standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), and percentage of NN50 (pNN50)], frequency-domain measures [total power, low frequency (LF), high frequency (HF), and LF/HF ratio], and nonlinear indices [standard deviation 1 (SD1) and standard deviation 2 (SD2)]. Statistical analysis was performed to compare pre- and postprocedure values, with the objective of evaluating the effect of PMBC on sympathovagal balance.

Results: Post-PMBC, there was a significant reduction in HR (P = 0.004) and LF/HF ratio (P < 0.001), indicating a shift toward parasympathetic dominance. SDNN and RMSSD values improved significantly (P < 0.001), suggesting enhanced autonomic function. These autonomic improvements may contribute to enhanced cardiovascular regulation and reduced sympathetic drive.

Conclusion: PMBC significantly enhances autonomic function, as reflected by improved HRV parameters. These changes suggest better cardiovascular autonomic regulation, although direct cardiovascular risk was not assessed in this study. HRV analysis can serve as a valuable tool for assessing recovery and guiding postprocedural management in MS patients.