Key result
Balloon mitral valvotomy significantly improved left ventricular global longitudinal strain from baseline (-13.10) to one month (-17.20) in patients with severe rheumatic mitral stenosis.
Why the study?
Rheumatic mitral stenosis is a major cause of cardiovascular morbidity in developing countries, prompting evaluation of subclinical biventricular dysfunction and the effect of balloon mitral valvotomy using speckle tracking echocardiography.
Does balloon mitral valvotomy improve left and right ventricular strain and deformation in patients with severe rheumatic mitral stenosis?
Observational (n=60)
Does balloon mitral valvotomy improve left and right ventricular strain and deformation in patients with severe rheumatic mitral stenosis?
p-value: p=<0.05
Balloon mitral valvotomy significantly improves subclinical left and right ventricular dysfunction, as measured by speckle tracking echocardiography, in patients with severe rheumatic mitral stenosis.
May indicate early LV recovery post-BMV in rheumatic MS; hypothesis-generating and requires randomized confirmation before practice change.
Background: Rheumatic mitral stenosis (MS) poses substantial burden in developing countries and is an important cause of cardiovascular morbidity. Speckle tracking echocardiography is a novel technique which assesses the left and right ventricular mechanics and deformation by grey scale imaging. Aims and Objectives: We aimed to assess the left and right ventricular strain and deformation in patients with severe rheumatic mitral stenosis to analyse the subclinical ventricular dysfunction in these patients as compared to healthy controls and to see the effect of balloon mitral valvotomy (BMV) on these parameters. Material and Methods: 50 patients of severe rheumatic mitral stenosis were recruited into study and divided into two groups: cases ( severe MS patients underging BMV, n = 30 ) case controls(severe MS patients on medical management not opting for BMV, n = 20). 10 -healthy normal controls were taken. Baseline LV strain and deformation was assessed in these patients and effect of balloon mitral valvotomy was seen on these parameters in cases at early (24-48 hrs) and short term (1-month) period as compared to changes in case controls and normal controls. Results: Baseline LV global longitudinal (GL) (-13.1 ± 3.67) and circumferential strain (GC) (-19.18 ± 7.58) was significantly reduced in cases as compared to healthy controls (-22.17 ± 2.30) and (-30.21 ± 4.17) respectively (p < 0.001). Right ventricular global longitudinal strain was also significantly reduced in cases (-9.43 ± 5.75). LV and RV rotational parameters were also reduced. BMV significantly improved in left ventricular GL strain from baseline (-13.10 ± 3.67) to post 24-48 hrs (-14.77 ± 3.98) and post one month (-17.20 ± 3.44) and GC strain from baseline (-19.18 ± 7.58, p=<0.05). RV global longitudinal strain also changed significantly (p < 0.01) from baseline (-9.43 ± 5.75) to post 24-48 hrs (-13.87 ± 8.93) and post one month (-17.37 ± 5.72). Conclusions: LV and RV strain and deformation is reduced in severe mitral stenosis patients. 2D speckle tracking echocardiography can detect these early changes in LV and RV function before overt systolic dysfunction. BMV significantly improves LV/RV strain and deformation at early and short term period.
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Vijay et al. (2019) conducted an observational in Severe rheumatic mitral stenosis (n=60). Balloon mitral valvotomy (BMV) vs. Medical management and healthy controls was evaluated on Left ventricular global longitudinal strain (p=<0.05). Balloon mitral valvotomy significantly improved left ventricular global longitudinal strain from baseline (-13.10) to one month (-17.20) in patients with severe rheumatic mitral stenosis.
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