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ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 4  |  Page : 150-159

The assessment of left/right ventricular strain and deformation in patients with severe rheumatic mitral stenosis before and after balloon mitral valvuloplasty using speckle tracking echocardiography


Department of Cardiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Correspondence Address:
Dr. Sudarshan Kumar Vijay
Department of Cardiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow - 226 010, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/heartindia.heartindia_37_19

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Background: Rheumatic mitral stenosis (MS) poses substantial burden in developing countries and is an important cause of cardiovascular morbidity. Speckle tracking echocardiography is a novel technique which assesses the left and right ventricular mechanics and deformation by grey scale imaging. Aims and Objectives: We aimed to assess the left and right ventricular strain and deformation in patients with severe rheumatic mitral stenosis to analyse the subclinical ventricular dysfunction in these patients as compared to healthy controls and to see the effect of balloon mitral valvotomy (BMV) on these parameters. Material and Methods: 50 patients of severe rheumatic mitral stenosis were recruited into study and divided into two groups: cases ( severe MS patients underging BMV, n = 30 ) case controls(severe MS patients on medical management not opting for BMV, n = 20). 10 -healthy normal controls were taken. Baseline LV strain and deformation was assessed in these patients and effect of balloon mitral valvotomy was seen on these parameters in cases at early (24-48 hrs) and short term (1-month) period as compared to changes in case controls and normal controls. Results: Baseline LV global longitudinal (GL) (-13.1 ± 3.67) and circumferential strain (GC) (-19.18 ± 7.58) was significantly reduced in cases as compared to healthy controls (-22.17 ± 2.30) and (-30.21 ± 4.17) respectively (p < 0.001). Right ventricular global longitudinal strain was also significantly reduced in cases (-9.43 ± 5.75). LV and RV rotational parameters were also reduced. BMV significantly improved in left ventricular GL strain from baseline (-13.10 ± 3.67) to post 24-48 hrs (-14.77 ± 3.98) and post one month (-17.20 ± 3.44) and GC strain from baseline (-19.18 ± 7.58, p=<0.05). RV global longitudinal strain also changed significantly (p < 0.01) from baseline (-9.43 ± 5.75) to post 24-48 hrs (-13.87 ± 8.93) and post one month (-17.37 ± 5.72). Conclusions: LV and RV strain and deformation is reduced in severe mitral stenosis patients. 2D speckle tracking echocardiography can detect these early changes in LV and RV function before overt systolic dysfunction. BMV significantly improves LV/RV strain and deformation at early and short term period.


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