Assessment of Interatrial Dyssynchrony by Tissue Doppler Imaging in Mitral Stenosis: Effect of Afterload Reduction After Balloon Mitral Valvuloplasty.

Abstract

Background: Atrial fibrillation (AF) predisposition in mitral stenosis (MS) has been studied using many electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (interatrial electromechanical delay). There are scarce data on the effect of percutaneous balloon mitral valvuloplasty (PBMV) on the interatrial electromechanical coupling in patients with MS. We aimed to assess the interatrial electromechanical coupling in MS before and after PBMV by tissue Doppler imaging (TDI) echocardiography. Patients and methods: This study included 45 patients suffered from moderate to severe MS who underwent PBMV successfully without complication and 20 healthy volunteers as a control group. We compared between both groups in the clinical, electrocardiographic and echocardiographic parameters. The patients with MS were re-evaluated one week after PBMV. Interatrial electromechanical delay (EMD) was estimated by TDI before and after PBMV and we compared the results. Results: The interatrial EMD (56.4  15.8 vs. 34.6  7.2 ms, p < 0.001) was higher in patients with MS as compared to healthy individuals. The maximum P-wave duration (P-max) and P-wave dispersion (PWD) showed highly significant positive correlation with the interatrial EMD (r = 0.37, p < 0.001 and r = 0.41, p < 0.001 respectively). There was a highly significant decrease in the interatrial EMD (56.4  15.8 vs. 38.3  10.4 ms, p < 0.001) one week after PBMV. Conclusion: The current study showed significant increase in the interatrial EMD in patients with moderate to severe MS. These changes improved significantly after PBMV.