Why the study?
Do patients with chronic rheumatic mitral regurgitation have impaired LA and LV longitudinal mechanics compared to healthy controls?
Observational (n=35)
No
Do patients with chronic rheumatic mitral regurgitation have impaired LA and LV longitudinal mechanics compared to healthy controls?
Impairment of LA longitudinal function can precede impairment in LV longitudinal mechanics in chronic rheumatic MR, suggesting PALS may be a sensitive marker of severe MR.
Introduction: There is a paucity of data on left atrial (LA) and left ventricular (LV) deformation characteristics in patients with chronic, isolated, rheumatic mitral regurgitation (MR).Methods: This observational study was conducted at Nizams Institute of Medical Sciences, Hyderabad between January and June 2014.Sixteen patients with chronic isolated moderate or severe rheumatic MR (all in sinus rhythm) were compared to 19 healthy age and gender matched controls.All patients underwent imaging using a Philips iE33 2D system with an S5-1 transducer.The assessment of MR severity was based on standard guidelines.Speckle tracking analyses were performed using the Philips QLAB 9 quantification software.Patients with poor images and conflicting comorbidities were excluded.Results: The mean age of patients with chronic MR was 31 AE 11 years with 12 females (75%).Left ventricular ejection fraction was >60% in 12 patients and subnormal (50-60%) in 4 patients.There was no difference in peak LA global longitudinal strain (PALS) between the chronic MR and the control group (26 AE 10% vs. 31 AE 6%, p = 0.12).There was a difference in peak LV global longitudinal strain (PVLS) between chronic rheumatic MR and control group (À19 AE 3 vs.À17 AE 2%, p = 0.03).In the chronic MR group 5 (31%) of the patients had decreased PALS and normal PVLS, 6 (37%) had decreased PALS and PVLS, 5 (31%) had normal PALS and PVLS.None of the patients had a normal PALS with impaired PVLS.There was a negative correlation between the mean PALS and PVLS (r = À0.7).Conclusion: There is a strong correlation between impairment of LA and LV longitudinal mechanics in chronic rheumatic MR.However, impairment of LA longitudinal function can precede impairment in LV longitudinal mechanics.These data suggest that reduction in PALS may be a more sensitive marker of severe MR than reduction in PVLS.The clinical significance of this finding needs to be validated in a larger cohort.
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Patil et al. (2015) conducted an observational in Chronic, isolated, rheumatic mitral regurgitation (MR) (n=35). Chronic isolated moderate or severe rheumatic mitral regurgitation vs. Healthy age and gender matched controls was evaluated on Peak LV global longitudinal strain (PVLS) (p=0.03).
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