Key result
Rheumatic mitral stenosis is linked to lower GLSS versus controls, with further reductions in AF.
Why the study?
Two-dimensional strain imaging offers a more objective and quantitative evaluation of LV systolic function without limitations of EF and Doppler methods in patients with mitral stenosis.
Does two-dimensional strain imaging detect left ventricular systolic dysfunction in patients with rheumatic mitral stenosis compared to healthy controls?
Cross-Sectional (n=30)
Does two-dimensional strain imaging detect left ventricular systolic dysfunction in patients with rheumatic mitral stenosis compared to healthy controls?
p-value: p=<0.001
2D strain imaging reveals subclinical left ventricular systolic dysfunction in patients with rheumatic mitral stenosis despite normal ejection fraction, particularly in those with concomitant atrial fibrillation.
2D strain may detect subclinical LV dysfunction in rheumatic mitral stenosis; leaves open prospective validation and management impact.
Introduction: Two-dimensional (2D) strain is a novel technique which evaluates left ventricular (LV) systolic functions more objectively and quantitatively and does not have the limitations seen in ejection fraction (EF), tissue Doppler imaging, and Doppler strain. In this study, we aimed to evaluate the role of 2D strain in the assessment of LV systolic function and the relationship between the presence of atrial fibrillation (AF) and LV dysfunction in patients with mitral stenosis (MS).Materials and Methods: This study is a cross-sectional study. The 2D strain was obtained from LV apical LAX, 4C, and 2C view. Peak LV longitudinal systolic strain was calculated for apical LCX, 4C, and 2C view, and global LV systolic strain was calculated by averaging the three apical views.Results: A total of thirty patients were enrolled in the study. They included 24 (80%) females and 6 (20%) males. There were 11 patients (36.7%) had AF and 21 patients (63.3%) had sinus rhythm. There were mean mitral valve area 1.17 cm2 (by planimetry) and 1.19 cm2 (by pressure half-time), mean mitral valve gradient 12.0 mmHg, mean peak gradient 22 mmHg, and mean right ventricular systolic pressure (50.6 vs. 37.4 mmHg) compared to sinus group. In this study, the mean ALAX LSS (−15.12), mean A4C LSS (−14.65), mean A2C LSS (−13.89), and mean GLOBAL LSS (−14.52) were statistically significant (P < 0.001) lower than the control group. Among AF groups, there were statistically significant (P < 0.05) lower A2C LSS and GLOBAL LSS, but there was no significant difference in ALAX LSS and A4C LSS in both groups.Conclusion: Despite normal LV dimensions and EF, there was a highly significant lower (P < 0.001) global longitudinal systolic strain (GLSS) in MS patients compared to healthy controls. Patients with AF had significantly lower GLSS value (P < 0.05) than the sinus rhythm group among patients with MS.
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Singh et al. (2020) conducted a cross-sectional in Rheumatic mitral stenosis (n=30). Rheumatic mitral stenosis vs. Healthy controls was evaluated on Global left ventricular longitudinal systolic strain (p=<0.001). Patients with rheumatic mitral stenosis had significantly lower global longitudinal systolic strain compared to healthy controls (mean -14.52, P<0.001), which was further reduced in those with atrial fibrillation (P<0.05).
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