Left ventricular mechanics in isolated mild mitral stenosis: a three dimensional speckle tracking study

Abstract

In a fraction of patients with mild mitral stenosis, left ventricular systolic function deteriorates despite the lack of hemodynamic load imposed by the dysfunctioning valve. Neither the predisposing factors nor the earlier changes in left ventricular contractility were understood adequately. In the present study we aimed to evaluate left ventricular mechanics using three-dimensional (3D) speckle tracking echocardiography. A total of 31 patients with mild rheumatic mitral stenosis and 27 healthy controls were enrolled to the study. All subjects included to the study underwent echocardiographic examination to collect data for two- and three-dimensional speckle-tracking based stain, twist angle and torsion measurements. Data was analyzed offline with a echocardiographic data analysis software. Patients with rheumatic mild MS had lower global longitudinal (p < 0.001) circumferential (p = 0.02) and radial (p < 0.01) strain compared to controls, despite ejection fraction was similar for both groups [(p = 0.45) for three dimensional and (p = 0.37) for two dimensional measurement]. While the twist angle was not significantly different between groups (p = 0.11), left ventricular torsion was significantly higher in mitral stenosis group (p = 0.03). All strain values had a weak but significant positive correlation with mitral valve area measured with planimetry. Subclinical left ventricular systolic dysfunction develops at an early stage in rheumatic mitral stenosis. Further work is needed to elucidate patients at risk for developing overt systolic dysfunction.

Correlation and agreement between 2D and 3D speckle‐tracking echocardiography for left ventricular volumetric, strain, and rotational parameters in healthy volunteers and in patients with mild mitral stenosis

“…Mean age of the whole study population was 38.19 ± 9.28 years, 37 out of 58 (63.8%) participants were female, mean body surface area was 1.85 ± 0.17 m 2 , mean body mass index was 26.14 ± 3.10, mean systolic blood pressure was 124.53 ± 5.97 mm Hg, and mean diastolic blood pressure was 72.24 ± 4.91 mm Hg. Data regarding demographic and anthropometric variables for the MS and control groups were reported earlier, and there were no significant differences regarding these variables between the study and control groups . For patients with MS, mean transmitral gradient was 3.61 ± 1.48 mm Hg and mitral valve area was measured as 2.04 ± 0.43 cm 2 with 2D planimetry.…”

“…The inclusion/exclusion criteria for this study, including the flowchart for patient enrollment and study procedures, were described previously . In brief, 31 patients with mild MS and 27 healthy volunteers that gave consent for the study were consecutively enrolled, for example, patients with accompanying cardiomyopathies, valve diseases other than mitral valve disease, more than mild mitral regurgitation, atrial fibrillation, or other rhythm abnormalities that may affect left ventricular (LV) contractility or prevent adequate image acquisition, previous cardiac surgery, and coexisting noncardiac disorders that could affect LV contractility (such as thyroid disorders).…”

“…All echocardiographic examinations were performed with Philips iE33 echocardiography platform equipped with a X5 2D/3D matrix array transducer (Phillips Healthcare). The methods of image acquisition for two‐ and three‐dimensional images, as well as offline image analyses and measurements, were described in the earlier study . Only patients with mild MS were included in the MS arm in the previous study, in which the planimetric valve area was defined to be between 1.5 and 2.0 cm 2 with one of the following criteria: (a) mitral valve area as calculated with pressure half‐time method > 1.5 cm 2 or (b) mean transmitral gradient < 5 mm Hg.…”

“…3DSTE analysis was described in detail in the previous study . All 3D volumetric and STE analyses were performed using vendor‐independent software (4D LV Analysis; TomTec Imaging Systems).…”

“…Our group has previously studied left ventricular mechanics in patients with mitral stenosis (MS) and in healthy volunteers using 2D and 3D STE. In the previous study, we have found a significant reduction in LV global strain in all directions of contraction and increased LV torsion in patients with mild MS, but the analysis of data was largely restricted to 3DSTE findings . This study was conducted using the images and data obtained for the previous study to analyze the correlation and agreement between 2DSTE and 3DSTE findings and to test the hypothesis that the agreement between these two modalities might differ between healthy persons and patients with an underlying cardiovascular condition, such as MS.…”