Left Atrial Appendage Mechanical Changes in Patient with Mitral Stenosis Speckle Tracking Imaging Study

Abstract

Background: LAA is the major site of thrombus formation in mitral stenosis;active LAA blood flow and contractile function may be disturbed in MS. TEE is the modality of choice for evaluating LAA and Speckle-tracking echocardiography (STE) is a recently developed technique for the characterization and quantification of myocardial deformation. It permits measurement of LA and LAA strain and strain rate which can be used to assess the mechanical function of LAA. Objective: To assess the mechanical function of left atrial appendage (LAA) in mitral stenosis (MS) patients with sinus rhythm by 2D speckle tracking strain and strain rate through transesophageal echocardiography (TEE). Patients & Method: Thirty-three patients with moderate to severe MS and sinus rhythm, 38.33 ± 5.66 years as a case group and twenty-two age and sex matched healthy volunteers as a control group. All participants underwent compete conventional transthoracic echocardiography; TEE for assessment of LAA morphology and Doppler flow and speckle tracking strain & strain rate were measured from LAA walls. Results: LAA Doppler flow peak velocities, LAA strain, reservoir strain rate (RSr), conduit strain rate (CSr) and atrial contractile strain rate (ASr) all were significantly lower in patient group. Global Strain of LAA had a negative correlation with LA diameter, pulmonary artery systolic pressure & degree of spontaneous echo contrast and a positive correlation with MS area and LAA Doppler flow.Conclusion: 2D speckle tracking strain and strain rate of LAA is a feasible technique and is significantly reduced in patients with mitral stenosis even with sinus rhythm.