Comparative assessment of left and right atrial deformation using 2D and 3D speckle-tracking echocardiography in healthy individuals and rheumatic mitral stenosis patients with/without atrial fibrillation

BACKGROUND: Rheumatic mitral stenosis continues to be a significant public health issue in developing countries. Advances in echocardiography have made it possible to non-invasively assess atrial physiomechanics. In our study, we aimed to evaluate the changes in left and right atrial phasic functions in patients with have mitral stenosis and to investigate the relationship of these changes with clinical signs, symptoms, and intervention decisions. METHODS: Patients with rheumatic mitral stenosis who did not have comorbidities affecting cardiac function were included in this single-center, prospective study. The study population consisted of 122 subjects: 30 healthy controls with no chronic diseases and normal cardiac function confirmed by clinical and echocardiographic evaluations, 31 patients with moderate mitral stenosis, 31 patients with severe mitral stenosis and 30 patients with severe mitral stenosis with valvular atrial fibrillation. In addition to conventional echocardiographic parameters, biventricular deformation analyses were assessed using 2D-STE. Right and left atrial phasic functions were evaluated using both 2D and 3D-STE analysis and compared with clinical findings. RESULTS: In the patient group with severe mitral stenosis in sinus rhythm, the contractile left atrial strain values were significantly higher. The left atrial peak longitudinal (reservoir) strain values were found to be significantly lowest in the group with severe mitral stenosis accompanied by atrial fibrillation. Similarly, in the group with severe mitral stenosis accompanied by atrial fibrillation, the right atrial phasic strain values were significantly lower in both 2D and 3D measurements. CONCLUSION: Mitral stenosis, the increased left atrial afterload in patients with sinus rhythm is compensated by an increase in contractile function. However, this compensatory increase is insufficient to preserve left atrial reservoir function. Patients with mitral stenosis who develop atrial fibrillation lack the compensatory contractile function, and this deficiency underlies the increased clinical deterioration associated with the development of atrial fibrillation.