Key result
Severe rheumatic mitral stenosis was associated with significantly reduced left atrial reservoir strain compared to healthy controls (14.73% vs 44.11%, p<0.001).
Why the study?
The study aimed to evaluate left atrial function using two-dimensional speckle tracking echocardiography in severe rheumatic mitral stenosis and examine its correlation with clinical symptoms and echocardiographic parameters.
Does two-dimensional speckle tracking echocardiography detect left atrial dysfunction in patients with severe rheumatic mitral stenosis compared to healthy controls?
Case-Control (n=120)
Does two-dimensional speckle tracking echocardiography detect left atrial dysfunction in patients with severe rheumatic mitral stenosis compared to healthy controls?
Absolute Event Rate: 14.73% vs 44.11%
p-value: p=<0.001
Severe rheumatic mitral stenosis is associated with significantly compromised left atrial reservoir, conduit, and contractile function as assessed by speckle tracking echocardiography, which correlates with disease severity and symptoms.
Speckle tracking may detect left atrial dysfunction in severe rheumatic mitral stenosis; leaves open impact on risk stratification or management.
Aim: The aim of this study was to assess the left atrial (LA) function in severe rheumatic mitral stenosis (MS) patients using two-dimensional speckle tracking echocardiography (STE) and its correlation with clinical symptoms and echocardiography parameters. Methods: A total of 120 subjects (80 patients with isolated severe MS [mitral valve area (MVA) ≤1.5 cm2] in sinus rhythm and 40 healthy controls) underwent comprehensive echocardiography including STE for assessment of LA strain [reservoir strain (LASr), conduit strain (LAScd) and contractile strain (LASct)]. Results: The mean MVA in cases was 0.93 ± 0.21 cm2. The mean values of LASr (14.73 ± 8.59%), LAScd (-7.61 ± 4.47%) and LASct (-7.16 ± 5.15%) among cases were significantly less (p< 0.001) when compared to controls where the values were 44.11 ± 10.44%, -32.45 ± 7.63%, -11.85 ± 6.77% respectively. Thus the compensatory LA contractile function was also compromised. The New York Heart Association (NYHA) class III, II and I dyspnea was present in 37 (46.25%), 38 (47.5%) and 5 (6.25%) subjects respectively. All the three LA strain parameters showed a trend towards decline with increase in severity of MS, increase in LA size, increase in mean and peak diastolic transmitral gradients and with higher NYHA functional class. Conclusion: Left atrial dysfunction is common in severe rheumatic MS as suggested by severely reduced LA reservoir, conduit and contractile strain. Early and timely intervention in these patients irrespective of NYHA functional class is advocated as it may likely improve the LA function and avoid clinical deterioration.
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Mehta et al. (2021) conducted a case-control in Severe rheumatic mitral stenosis (n=120). Severe rheumatic mitral stenosis vs. Healthy controls was evaluated on Left atrial reservoir strain (LASr) (p=<0.001). Severe rheumatic mitral stenosis was associated with significantly reduced left atrial reservoir strain compared to healthy controls (14.73% vs 44.11%, p<0.001).
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