Impact of Rheumatic Process in Left and Right Ventricular Function in Patients with Mitral Regurgitation

Abstract

Background: Mitral regurgitation (MR) burdens the left and right ventricles with a volume or pressure overload that leads to a series of compensatory adaptations that eventually lead to ventricular dysfunction, and it is well known that in rheumatic heart disease (RHD) that the inflammatory process not only occurs in the valve but also involves the myocardial and pericardial layers. However, whether the inflammatory process in rheumatic MR is associated with ventricular function besides hemodynamic changes is not yet established.Purpose: Evaluate whether rheumatic etiology is associated with ventricular dysfunction in patients with chronic MR. Methods:The study population comprised patients aged 18 years or older included in the registry who had echocardiography performed at the National Cardiovascular Center Harapan Kita in Indonesia during the study period with isolated primary MR due to rheumatic etiology and degenerative process with at least moderate regurgitation. Results:The current study included 1,130 patients with significant isolated degenerative MR and 276 patients with rheumatic MR. Patients with rheumatic MR were younger and had a higher prevalence of atrial fibrillation and pulmonary hypertension, worse left ventricle (LV) ejection fraction and tricuspid annular plane systolic excursion (TAPSE) value, and larger left atrium (LA) dimension compared to patients with degenerative mitral regurgitation (MR). Gender, age, LV end-systolic diameter, rheumatic etiology, and TAPSE were independently associated with more impaired LV ejection fraction. Whereas low LV ejection fraction, LV end-systolic diameter, and tricuspid peak velocity (TR) peak velocity >3.4 m/s were independently associated with more reduced right ventricle (RV) systolic function (Table 3). Conclusions:Rheumatic etiology was independently associated with more impaired left ventricular function; however, rheumatic etiology was not associated with reduced right ventricular systolic function in a patient with significant chronic MR.

Clinical Outcome of Rheumatic Mitral Valve Repair and Replacement Surgery in Indonesia; A Comparison with Non-Rheumatic Aetiology

“…Interestingly, although not correlated with the outcome, the LVEF in our RHD group was significantly lower than in our non-RHD group. The same finding was also reported by Rudiktyo et al [33], suggesting that besides the chronic load of the left ventricle, there could be another mechanism that worsens the LV function in patients with rheumatic MR. Other studies reported that the intrinsic myocardial process in RHD may play a role in the mechanism of this impaired LV contractility, as shown in the cardiac MRI and strain echocardiography [34,35]. Reduced LV and RV function, older age, more complex valve lesions, and a high AF proportion suggested that most of our patients presented in their late stages.…”

Echocardiographic Parameters and Complication Profiles Among Adult Patients with Rheumatic Heart Disease at Jimma Medical Center

“…Regarding the echocardiographic findings, nearly one-fifth of the study participants (18.3%) have severely reduced left ventricular systolic dysfunction; the mean LVSd was 54.4±8.3mm; this study resembles a study by Rudiktyo et al, where the patients have a mean of 56.63 ± 8.57mm. 26 This study discovered that the mean left ventricular posterior wall end diastole and end systole (LVPWd) was found to be 10.01±1.18mm. This finding is higher than a study conducted in Multan, Pakistan, where the mean LVPWd was reported as 7.13 ± 1.95mm 27 and another study by Meel et al from South Africa also reported a mean LVPWd of 8.5 ± 1.5mm.…”

“…Regarding the echocardiographic findings, nearly one-fifth of the study participants (18.3%) have severely reduced left ventricular systolic dysfunction; the mean LVSd was 54.4±8.3mm; this study resembles a study by Rudiktyo et al, where the patients have a mean of 56.63 ± 8.57mm. 26 …”