Prediction of subclinical left ventricular dysfunction with longitudinal two-dimensional strain and strain rate imaging in patients with mitral stenosis

Abstract

Longitudinal two-dimensional strain deformation is a novel technique which evaluates global and regional left ventricular (LV) function with high reproducibility. The aim of the study was to investigate the global and regional systolic function using this method in patients with pure mitral stenosis (MS). Conventional echocardiography and longitudinal two-dimensional strain analysis were performed in 60 patients (41 +/- 5 years, 48 women) with mild to moderate MS (mitral valve area: 1.9 +/- 0.5 cm(2)), and 52 healthy controls (40 +/- 7 years, 37 women). For strain analysis standard apical views were obtained, and by using a software system peak systolic strain and strain rate were calculated off-line in each segment. In all, 88% of the segments could be optimally tracked by the software system. Despite normal LV systolic function as assessed by ejection fraction (66 +/- 8%), mean global longitudinal strain (GLS) and global longitudinal strain rate (GLSR) were significantly reduced in patients with isolated MS (GLS -17 +/- 3.3 vs. -19 +/- 2.5%, P = 0.006 and GLSR -1.3 +/- 0.3 vs. -1.5 +/- 0.3 s(-1), P < 0.0001). Regional analysis demonstrated that patients with MS had a significantly reduced longitudinal peak strain and strain rate in all basal, and some mid (inferior, anteroseptal, interventricular septum) segments of the left ventricle. For other segments longitudinal peak strain and strain rate values were similar among the groups. Evaluation of LV systolic function by longitudinal two-dimensional strain deformation identified early abnormalities in MS patients who had apparently normal standard systolic function.

Severity of Mitral Stenosis and Left Ventricular Mechanics: A Speckle Tracking Study

“…Examples include ischemic/non-ischemic cardiomyopathy [23] and hypertrophic cardiomyopathy [24]. However, there is only one 2D strain imaging study in the literature related to MS [18]. …”

“…In the diagnosis of LV dysfunction due to MS, some studies have shown EF, TDI, and Doppler strain to be useful [14,15,16,17]. However, studies related to the use of 2D strain, a more objective technique in the diagnosis of LV systolic function in MS, are very limited [18]. In this study, we aimed to evaluate the role of 2D strain in the assessment of subclinical LV systolic dysfunction and the relationship between stenosis severity and LV dysfunction in patients with MS.…”

Acute Impact of Balloon Mitral Valvotomy on Left Atrial Functions in Mitral Stenosis

“…30 Consequent to these changes (structural remodeling), the atrial myocytes lose their normal contraction and relaxation functions. 31 Hemodynamically, narrowing of mitral orifice poses increased resistance to LA emptying i.e. increased LA afterload.…”

Evaluation of left ventricular function with strain/strain rate imaging in patients with rheumatic mitral stenosis

“…Özdemir et al (11) determined subclinical insufficiency in all of the basal segments and some of the mid segments in 60 patients with mild-moderate mitral stenosis. However, in that study, measurements were taken differently via average global longitudinal strain and strain rate imaging techniques.…”

“…While SE is affected by preload and heart rate, SRE shows parallelism to inotropic conditions and contractility, independently from the loading conditions (7,8). Recently, it was reported in several studies that, subclinical LV dysfunction was demonstrated via that imaging methods in patients having pure mitral stenosis and normal LV function with traditional echocardiography (9)(10)(11). In these studies, commonly, particular segments of LV were evaluated.…”