Left Ventricular Long‐Axis Function Is Reduced in Patients with Rheumatic Mitral Stenosis

Abstract

Left ventricular long-axis function evaluated by M-mode or tissue Doppler echocardiography has been shown to be useful indexes of left ventricular systolic function; however it has not been evaluated in patients with mitral stenosis. We examined the left ventricular long-axis function of the patients with pure mitral stenosis and normal global systolic function as assessed by fractional shortening of the left ventricle (LV). Fifty-two patients with pure mitral stenosis and twenty-two healthy controls were evaluated by echocardiography. Although there was no statistically significant difference in global systolic function, M-mode derived systolic motion of the septal side and (12 +/- 3 vs 14.4 +/- 1.5 mm, P = 0.016) the lateral side of mitral annulus (13.2 +/- 3 vs 16.8 +/- 2 mm, P = 0.001) were both significantly lower in the patients with mitral stenosis than control subjects. Similarly tissue Doppler systolic velocity of the septal annulus (7.6 +/- 1.1 vs 10.4 +/- 3.2 cm/s, P = 0.03) and lateral mitral annulus (7.6 +/- 1.1 vs 10.4 +/- 3.2 cm/s, P = 0.003) were also significantly lower in patients with mitral stenosis than in controls. There was a statistically significant correlation between septal annular motion and annular velocity (r = 0.643, P = 0.002). Septal annular motion and annular velocity were also correlated with left atrial ejection fraction (r = 0.338, P = 0.005 and r = 0.676, P = 0.001, respectively). Thus, patients with mitral stenosis had significantly impaired long-axis function evaluated by M-mode or tissue Doppler echocardiography despite normal global systolic function.

Annular Systolic Velocity Predicts the Presence of Spontaneous Echo Contrast in Mitral Stenosis Patients with Sinus Rhythm

“…The excursion of the Clinical Cardiology DOI:10.1002/clc mitral annulus contributes to LA filling by creating a suction effect during systole and contributes to LA emptying by decreasing LA volume during diastole. 17 -19,25 Owing to extension of inflammation and scarring process from mitral valve to adjacent tissues, annular excursion and LA functions are impaired in MS. 20,21Ö zer et al 20 found that reduction in the annular systolic velocity was positively correlated with reduction in LA EF and annular excursion in these patients. However, they suggested that reduction in the annular systolic velocity might reflect the widespread influence of the inflammatory process on cardiac structures.…”

“…Consequently, left ventricular systolic performance is reduced in these patients in the long run. 20,21 Lower FIG. 4 The ROC curve of annular systolic velocity for predicting the prior thromboembolic event.…”

“…1 -3,5,9,11 -16 The mitral annulus has an important role for left atrial (LA) functions by moving throughout left ventricular long axis. 17 -19 Owing to inflammation and scarring process, the excursion of mitral annulus is restricted and annular velocities obtained by tissue Doppler imaging (TDI) are reduced in patients with MS. 20,21 Recently, it has been shown that reduction in annular systolic velocity reflects the reduction in LA systolic function. 20 The aim of the study was to investigate whether the annular velocities obtained by TDI can predict the presence of SEC seen by TEE in MS patients with SR.…”

Subclinical left ventricular systolic dysfunction in patients with mild-to-moderate rheumatic mitral stenosis and normal left ventricular ejection fraction: an observational study

“…Exclusion criteria were as follows: 1. LV EF 50%, 2. mitral regurgitation more than mild degree, 3. aortic regurgitation more than mild degree or aortic stenosis, 4. tricuspid stenosis, 5. clinical, echocardiographic or angiographic evidence of coronary artery disease (CAD), 6. hypertension, 7. diabetes mellitus, 8. atrioventricular conduction abnormalities, 9. severe calcification of mitral valve annulus, 10. clinical or laboratory evidence of active rheumatic disease, 11. low quality echocardiographic image for TDI and VVI analyses, 12. atrial fibrillation.…”

“…However, there are some studies pointing out impaired LV systolic function in pure MS (4)(5)(6)(7). Myocardial structural changes and hemodynamic factors may play a role in the impairment of LV systolic function.…”