Left atrial strain predicts improvement in left atrial functions of severe rheumatic mitral stenoses undergoing successful percutaneous transmitral commissurotomy

Abstract

Aims Chronic rheumatic heart disease (RHD) is prevalent in India. The mitral valve in isolation or combination with the aortic or tricuspid valve is involved in 31.6% and 52.8% of chronic RHD patients, respectively. The left atrium (LA) functions as a reservoir during the cardiac cycle. Therefore, the LA enlargement leads to longitudinal lengthening, measured as a positive strain, permitting the measurement of the longitudinal strain of LA. This study aimed to assess the LA functions using peak atrial longitudinal strain (PALS) in patients with severe rheumatic mitral stenoses (MS) in sinus rhythm who underwent successful percutaneous transvenous mitral commissurotomy (PTMC). Material and Methods We recruited 56 patients with severe rheumatic MS for the study, of which 06 PTMC procedures were considered unsuccessful. So, 50 patients of chronic severe rheumatic MS in sinus rhythm undergoing PTMC were enrolled in a tertiary care centre of the Armed Forces from August 2017 to May 2019. Patients included in the study were not consecutive, and patients with atrial fibrillation (AF) were excluded. Results PALS improved post‑PTMC (P < .001) in this study, effectively concluding that PALS is impaired in patients with severe symptomatic MS and is acutely enhanced after treatment. Conclusions PALS is a good indicator of LA function and may predict the success of PTMC on the rheumatic mitral valve.

Potential Diagnostic and Prognostic Values of Left Atrial Strain in Valvular Heart Disease

“…[ 75 76 ] This immediate improvement of LAS-r post balloon valvuloplasty can be used as a good indicator of the procedure success in addition to MV area increase and transvalvular pressure gradient reduction. [ 67 77 ] Roslan et al . described an improvement of LAS-r from 11.23% ± 6.83% prevalvuloplasty to 16.80% ± 8.82% at 6 months postvalvuloplasty.…”