Impact of the Severity of Mitral Stenosis on the LV Systolic function as assessed by 2D Strain using Speckle tracking

Background Rheumatic heart disease remains a considerable cause of cardiovascular morbidity and mortality in developing countries and mitral stenosis is the most common valve affection of rheumatic heart disease worldwide.The left ventricular ejection fraction is the most widely used index of contractile function, but due to the visual component, assessment of endocardial excursion is subjective leading to inter-observer variability.Speckle-tracking echocardiography is an imaging technique developed as a method to objectively quantify myocardial function and analyzes cardiac motion and deformation by tracking naturally occurring speckle patterns in the myocardium. Objective To evaluate the effect of the severity of mitral stenosis on LV systolic function as assessed by speckle tracking. Patients and Methods This study was a case-control study involving 80 individuals which included 60 patients having mitral stenosis who presented to the outpatient clinics of Ain Shams University Hospitals and 20 healthy volunteers, The patients suffering from mitral stenosis were subdivided into 3 sub-groups: GROUP(1) 20 Patients having severe mitral stenosis (MV Area less than 1 cm²) GROUP (2) 20 Patients having moderate mitral stenosis (MV Area more than 1 cm² and less than 1.5 cm²) GROUP(3) 20 Patients having mild mitral stenosis (MV Area more than 1.5 cm²) A Control group involved 20 healthy volunteers recruited from health care workers in Ain Shams University hospitals. Results Study included 60 patients,16 males (26.7%) and 44 females (73.3%), with mean age of 41.30 ± 8.64 years. Patients living in rural Areas were 34 (57.7%) while those in urban areas were 26 (43.3%).Which was significant.There was no significant difference between gender or habitat and the severity of mitral Stenosis.There was a strong significance between the duration of the disease and its severity. The more the duration of mitral Stenosis, the more severe the mitral stenosis.A strong positive relation was noticed between the severity of mitral stenosis and both RVSP and LA diameter, while a strong negative relation between severity of mitral stenosis and GLPS. GLPS was affected in severe mitral stenosis only. Conclusion Subtle LV systolic dysfunction is present in large number of patients with severe mitral stenosis even in patients with normal ejection fraction by conventional 2D echocardiography.There was a significant relationship between the duration of mitral stenosis and its severity. The longer the duration of mitral stenosis, the more severe the mitral stenosis.Speckle tracking echocardiography (STE) can play a great role in identification of higher risk subgroups in whom earlier and more aggressive intervention could have a significant impact on their prognosis.