Strain imaging to assess early effects of successful percutaneous balloon mitral valvotomy on left atrium mechanics

Abstract

BackgroundGlobal left atrial strain (LA) has been used as a novel assessment tool to evaluate left atrial function. However, not much has been investigated to study the effect of percutaneous balloon mitral valvotomy (BMV) in patients with rheumatic severe mitral stenosis on global LA strain. We studied the relationship between global left atrial (LA) strain and severe mitral stenosis and the effect of BMV on LA strain.ResultsA total of 29 patients satisfying the criteria for severe mitral stenosis underwent balloon mitral valvotomy (67% females; mean age, 39.53 ± 11.78 years). Global left atrial strain was assessed by speckle tracking echocardiography before and after valvuloplasty. Global LA strain was impaired in patients with severe mitral stenosis and improved 24–48 h following BMV (13.4 ± .75% vs 17.37 ± 6.95%, p < 0.001). There was a significant decrease in mitral mean gradient (MMG) (16.94 ± 6.62 mmHg vs 8.19 ± 4.01 mmHg, p < 0.001) and systolic pulmonary artery pressure (sPAP) (47.84 ± 9.07 mmHg vs 36.88 ± 7.69 mmHg, p < 0.001) after BMV. Mitral valve area (MVA) (1.045 ± 0.17 cm2 vs 1.94 ± 0.22 cm2, p < 0.001) significantly increased after BMV. Results were compared with 30 age- and sex-matched healthy controls.ConclusionGlobal LA strain can be taken as an indicator of left atrial function, and its improvement following valvotomy may be taken as a good indicator of successful BMV.

Comprehensive echocardiographic and speckle tracking strain analysis in rheumatic mitral stenosis patients before and after transvenous mitral commissurotomy

“…PTMC is generally associated with good outcomes with low procedural and long-term mortality, but with signi cant need for re-intervention in the future. [17][18][19] In term of left ventricular function, there is a notion that MS protects the LV, thus systolic function should be preserved [13]. Many studies have shown that the EF is indeed preserved pre and immediately post PTMC [2][3][4].…”

“…Speckle tracking strain allows us to look at subclinical left ventricle (LV) and right ventricle (RV) dysfunction by analyzing Global Longitudinal Strain (GLS), Right Ventricle Free Wall Strain (RVFW-S) and left atrial dysfunction by looking at Left Atrial Reservoir Strain (LAr-S) [5][6][7][8]. With regards to subclinical LV and RV dysfunction, there are prior studies showing reduction in Global Longitudinal Strain (GLS) and Right Ventricle Free Wall Strain (RVFW-S), but the study population is small, and these studies only analyzed pre and immediate post PTMC values [7][8][9][10][11][12][13][14]. To our knowledge, this is the rst study that tracks all aspects of strain (GLS, RVFW-S and LAr-S) pre, immediately and 6 months post procedure.…”

Left Atrial Function by Two-Dimensional Speckle Tracking Echocardiography in Patients with Severe Rheumatic Mitral Stenosis and Pulmonary Hypertension

“…Therefore patients with severe MS should be subjected to early and timely BMV so as to improve their LA function. 11,22 We also believe that intervention may have an impact on preventing these patients to develop atrial fibrillation (AF), RV dysfunction and improving their prognosis. In the study by Ancona et al 23 the degree of reduced LA systolic strain in patients with rheumatic MS correlated not only with worse cardiovascular outcomes during 3-year follow-up but also was the most powerful predictor of new onset AF at 4-year follow-up.…”

“…For all subjects, standard two-dimensional (2D), M-mode and Doppler echocardiograms were obtained according to the American Society of Echocardiography guidelines. 11 Baseline measurements included were LA dimension, LV internal dimension in diastole (LVID d ) and in systole (LVID s ) and LV ejection fraction (LVEF). MVA [?…”

“…LA dysfunction has been reported in patients with rheumatic MS. 10 However most studies have either assessed global LA strain, reservoir or conduit strain values with contractile strain being reported only in mild to moderate MS. 10,11 Only very limited data is available regarding all three strain parameters in patients with severe MS. In the present study we assessed LA function (reservoir, conduit strain and contractile strain) by two-dimensional speckle tracking echocardiography and its correlation with clinical symptoms and echocardiography parameters in patients with isolated severe MS with pulmonary hypertension and healthy controls.…”