Speckle-tracking Echocardiography as an Early Predictor for LV Dysfunction in Rheumatic Mitral Regurgitation

Background: Rheumatic heart disease (RHD) is a significant health concern in developing countries, with mitral regurgitation (MR) being a typical valvular lesion. MR is one of the early indications of RHD. The elevated chronic inflammatory markers indicate chronic low-grade carditis in RHD. Aim: This work aims to study the relationship between early subclinical left ventricular (LV) dysfunction within severe rheumatic MR and preserved LV systolic function patients. Patients and Methods: The study enrolled patients with RHD who had chronic severe asymptomatic MR and preserved LV systolic function without meeting the surgery criteria. The study included patients with mild rheumatic MR who were matched 1:1 based on their left ventricular ejection fraction (LVEF) and recruited from the cardiology department’s outpatient clinics. Results: Hundred patients with severe rheumatic MR with preserved LV systolic function without meeting the criteria for surgery or intervention, and 100 patients with mild rheumatic MR with normal LVEF. Severe rheumatic MR patients exhibited lower global longitudinal strain (GLS), larger LV dimensions and volumes, Left atrial (LA) volume index, and Pulmonary artery systolic pressure (PASP) than patients with mild rheumatic MR. Patients had impaired GLS with mean GLS −14.4 ± 0.5, which may lead to significant LV and LA diameters, volumes, and PASP. Conclusions: Two-dimensional speckle-tracking echocardiography enables early detection of subtle myocardial fiber impairment and offers valuable markers for cardiac dysfunction. In patients with severe rheumatic MR who do not meet surgery criteria, GLS proves to be more sensitive than LVEF in identifying early LV systolic function impairment and predicting symptom development during follow-up.