Left ventricular systolic function assessment with two-dimensional strain imaging among patients with rheumatic mitral stenosis

Abstract

Introduction: Two-dimensional (2D) strain is a novel technique which evaluates left ventricular (LV) systolic functions more objectively and quantitatively and does not have the limitations seen in ejection fraction (EF), tissue Doppler imaging, and Doppler strain. In this study, we aimed to evaluate the role of 2D strain in the assessment of LV systolic function and the relationship between the presence of atrial fibrillation (AF) and LV dysfunction in patients with mitral stenosis (MS). Materials and Methods: This study is a cross-sectional study. The 2D strain was obtained from LV apical LAX, 4C, and 2C view. Peak LV longitudinal systolic strain was calculated for apical LCX, 4C, and 2C view, and global LV systolic strain was calculated by averaging the three apical views. Results: A total of thirty patients were enrolled in the study. They included 24 (80%) females and 6 (20%) males. There were 11 patients (36.7%) had AF and 21 patients (63.3%) had sinus rhythm. There were mean mitral valve area 1.17 cm2 (by planimetry) and 1.19 cm2 (by pressure half-time), mean mitral valve gradient 12.0 mmHg, mean peak gradient 22 mmHg, and mean right ventricular systolic pressure (50.6 vs. 37.4 mmHg) compared to sinus group. In this study, the mean ALAX LSS (−15.12), mean A4C LSS (−14.65), mean A2C LSS (−13.89), and mean GLOBAL LSS (−14.52) were statistically significant (P < 0.001) lower than the control group. Among AF groups, there were statistically significant (P < 0.05) lower A2C LSS and GLOBAL LSS, but there was no significant difference in ALAX LSS and A4C LSS in both groups. Conclusion: Despite normal LV dimensions and EF, there was a highly significant lower (P < 0.001) global longitudinal systolic strain (GLSS) in MS patients compared to healthy controls. Patients with AF had significantly lower GLSS value (P < 0.05) than the sinus rhythm group among patients with MS.