Key result
Severe mitral regurgitation due to rheumatic heart disease showed no significant difference in left atrial strain (14.63% vs 20.45%; p=0.08) compared to mitral valve prolapse.
Why the study?
Whether the pattern of left ventricular and left atrial remodelling differs between primary mitral regurgitation due to rheumatic heart disease versus mitral valve prolapse was unknown.
Does the etiology of severe primary mitral regurgitation (MVP vs RHD) affect left atrial and left ventricular strain patterns?
Observational (n=50)
No
Does the etiology of severe primary mitral regurgitation (MVP vs RHD) affect left atrial and left ventricular strain patterns?
Absolute Event Rate: 14.63% vs 20.45%
p-value: p=0.08
Left atrial and left ventricular strain parameters are significantly impaired in severe primary mitral regurgitation compared to controls, but do not differ significantly between rheumatic and prolapse etiologies.
LA strain impairment in severe MR appears etiology-independent; leaves open whether strain informs etiology-specific management.
OBJECTIVE: Left atrial (LA) and left ventricular (LV) remodelling are the adaptive changes that occur in primary mitral regurgitation (MR) and are related to its clinical outcomes. Despite the pathophysiological differences in MR in rheumatic heart disease (RHD) and mitral valve prolapse (MVP), whether the pattern of LV and LA remodelling is different between the two conditions remains unknown. Hence, we compared the LA and LV strain pattern in MR due to RHD, the predominant etiology in developing countries topatients with MVP and age and sex-matched controls. METHODS: A total of 50 patients of severe MR which included 30 MVP MR and 20 RHD MR were assessed by strain imaging by speckle tracking echocardiography (STE) and were compared with age and sex-matched controls. 2D STE was used for LA and 3D STE was used for LV strain analysis. LA and LV strain parameters were compared between MVP MR and RHD MR groups. RESULTS: 30 patients with MVP and 20 with RHD were studied. 60% (n = 30) were symptomatic. Mean GLS was -17.2 ± 4.4% compared to -20 ± 3.2% among controls and mean LA strain was 17.35 ± 10.3% compared to 51.34 ± 11.5% among controls which were significantly lower (both p < 0.01). No significant difference in LA strain and GLS was found between MVP and RHD subgroups (LA strain 20.45 ± 11.9% and 14.63 ± 8.85%; p = 0.08; GLS - 18.25 ± 4.3% and-16.2 ± 4.6%; p = 0.12). PALS in the RHD group was lower compared to MVP(p = 0.08) which showed a trend towards significance. LV strain parameters showed no significant difference among the MVP and RHD groups. CONCLUSION: LA and LV strain parameters showed no significant difference in MR due to either RHD or MVP. There was a trend towards lower LA strain in RHD which needs validation with large multicentric studies. The current strain parameters from MVP with the prognostic value may be applied to MR of RHD etiology, pending confirmation of our results by other groups.
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Rajesh et al. (2020) conducted an observational in Severe primary mitral regurgitation (n=50). Rheumatic heart disease etiology vs. Mitral valve prolapse etiology was evaluated on Left atrial strain (p=0.08). Severe mitral regurgitation due to rheumatic heart disease showed no significant difference in left atrial strain (14.63% vs 20.45%; p=0.08) compared to mitral valve prolapse.
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