Left atrium function testing in pre- and post-balloon mitral valvotomy patients using 2d speckle tracking of strain imaging.

Background: Rheumatic Mitral stenosis is a concern in developing world. Quantification of the left atrium (LA) strain by bi-dimensional speckle tracking echocardiography is a new diagnostic technique. Objectives: To assess the left atrium function by Two-Dimensional Speckle-tracking echocardiography in patients with moderate to severe mitral stenosis (MS), among the patients undergoing balloon mitral valvotomy (BMV) procedure. Methodology: Echocardiography examination was conducted among 37 patients with rheumatic MS, before and after 24 hours of BMV were included. Functional assessment of LA was done by the assessment of MS by planimetry method, mean pressure gradient and two-dimensional speckle tracking echocardiography (STE). Distribution of mitral valve area (MVA), myocardial perfusion grade (MVG), LA volume, STE 4C and STE 2C were assessed before and after treatment. Comparison of variables between pre-test and post-test of mean pressure gradient (MPG), STE 4C, STE 2C and global longitudinal strain (GLS) was done using Student’s “t” test and comparison of MVA and LA volume was carried out using Wilcoxon signed rank test with p-value<0.05 considered as significant. Results: Mitral valve area increased to 1.7+0.11 cm2 post- BMV with a statistical significance of p<0.0001. LA volume showed a marked reduction after BMV i.e. 51.34 ± 20.14 sq.cm. There was a significant improvement in the LA strain i.e. STE 4C, STE 2C and GLA; with p<0.001. Conclusion: A marked improvement of the LA function among the patients with symptomatic mitral stenosis was observed, which was an indicator of successful BMV, with the aid of STE.