Three dimensional echocardiographic study of left atrial volumes and function correlated with functional capacity in patients with mitral stenosis

Background Left atrial (LA) impairment of reservoir and booster function using real-time three-dimensional direct volumetric echocardiographic study (RT3DE), has been found in rheumatic mitral stenosis (MS). In MS, RT3DE has not well studied. Aim This study designed to reveal NYHA functional class (FC) determinants in MS cases and to demonstrate the relationship between LA mechanics as measured by RT3DE and heart failure (HF) symptoms. Patients and Methods 55 consecutive cases (38 females and 17 males; age: 39.6 ± 11 years) with rheumatic MS underwent RT3DE to evaluate LA mechanics. Those results were then correlated with NYHA functional class. Results There were 22% in FC I, 42% in FC II and the remaining 36% in FC III. LAVmax, LAVmin, and LAVpreA were larger with decreased functional capacity. There was insignificant difference between NYHA functional classes. LAVmin presented positive correlation with NYHA functional classes. Total LAEV, total LAEF, LA expansion, active LAEV, and active LAEF, which reflect LA reservoir and booster functions, were also significantly lower in NYHA II and NYHA III when compared with NYHA I. Total LAEV, total LAEF, LA expansion, and LA booster function presented highly significant negative correlation with NYHA functional classes. Conclusion LA booster pump and reservoir dysfunctions are correlated with HF symptoms in MS. The deterioration of both LA reservoir and booster functions by RT3DE in MS with stepwise decline of NYHA functional class are important determinants of clinical symptoms, which may also play a role in management.