Muhammad Khaleel Iqbal, Muhammad Furrakh Maqbool, Shahzad Tawwab, Muhammad Saleem Awan, Tahir Naveed, Usman Mahmood Butt


Background: In rheumatic severe mitral regurgitation, earlier detection of left ventricular dysfunction is very necessary in order to refer the patients for surgery at appropriate time. This study tried to find a correlation between conventional parameters of left ventricular dysfunction with systolic strain rate. Methods: A descriptive correlational study conducted from September 2016 to March 2018. One hundred and ninety-two patients of severe rheumatic MR and fifty-eight healthy controls were included. Left ventricular ejection fraction (LVEF), end diastolic dimension (LVEDD) and end systolic dimension (LVESD) were measured. Healthy controls were taken as group-I and patients were divided into group-II (ejection fraction ≥60% and LVESD ≤40 mm), group-III (ejection fraction ≥60% and LVESD ≤41–50 mm), and group-IV (ejection fraction <60%). Systolic strain rate at medial wall (SSR-med), at lateral wall (SSR-lat) and average of both (SSR-avg) were also measured by tissue doppler method for each study subject. Results: Out of 250 study subjects, males were 113 (45.2%) and females were 137 (54.8%). Means of the age, LVEF, LVEDD and LVESD were 30.8±9.1, 60.0±8.3, 58.5±7.8 and 37.4±9.9 respectively. Group I, II, III and IV contained 58, 69, 67 and 56 subjects respectively. Comparing these groups, mean LVEF progressively decreased from 63.9%±2.2 in group-I to 46.2±6.5 in group-IV while means of LVEDD and LVESD progressively increased from 45.9±3.5 and 23.2±2.3 in group-I to 64.3±3.6 and 49.0±2.9 in group-IV respectively. Average systolic strain rate (SSR-avg) decreased progressively from 1.57±0.06 in group-I to 0.83±0.08 in group-IV. All the strain rates, i.e., SSR-med, SSR-lat and SSR-avg showed significant negative correlation with left ventricular dysfunction, i.e., the group number (p<0.001). Conclusion: Systolic strain rate measured by tissue doppler method have significant negative correlation with left ventricular dysfunction in patients having rheumatic chronic severe mitral regurgitation.

Keywords: Left ventricular dysfunction; Strain rate; Mitral regurgitation

Full Text:



Asghar U, Ghauri F Naeem MT, Amjad M. Prevalence of rheumatic heart disease in different regions of Pakistan. Pak J Med Health Sci 2017;11(3):1049–52.

Aurakzai HA, Hameed S, Shahbaz A, Gohar S, Qureshi M, Khan H, et al. Echocardiographic profile of rheumatic heart disease at a tertiary cardiac centre. J Ayub Med Coll Abbottabad 2009;21(3):122–6.

Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. Circulation 2017;135(25):e1159–95.

Yurdakul S, Doğan A, Aytekin S. Assessment of subclinical left ventricular systolic function using strain imaging in the follow-up of patients with chronic mitral regurgitation. Turk Kardiyol Dern Ars 2017;45(5):426–33.

Wang Q, Sun QW, Wu D, Yang MW, Li RJ, Jiang B, et al. Early detection of regional and global left ventricular myocardial function using strain and strain-rate imaging in patients with metabolic syndrome. Chin Med J (Engl) 2015;128(2):226–32.

Gupta A, Kapoor A, Phadke S, Sinha A, Kashyap S, Khanna R, et al. Use of strain, strain rate, tissue velocity imaging, and endothelial function for early detection of cardiovascular involvement in patients with beta-thalassemia. Ann Pediatr Cardiol 2017;10(2):158–66.

Collier P, Phelan D, Klein A. A test in context: myocardial strain measured by speckle-tracking echocardiography. J Am Coll Cardiol. 2017;69(8):1043–56.

Schmid J, Kaufmann R, Grübler MR, Verheyen N, Weidemann F, Binder JS. Strain analysis by tissue doppler imaging: comparison of conventional manual measurement with a semiautomated approach. Echocardiography 2016;33(3):372–9.

Kamperidis V, Marsan NA, Delgado V, Bax JJ. Left ventricular systolic function assessment in secondary mitral regurgitation: left ventricular ejection fraction vs. speckle tracking global longitudinal strain. Eur Heart J 2016;37(10):811–6.

Casas-Rojo E, Fernández-Golfin C, Moya-Mur JL, González-Gómez A, García-Martín A, Morán-Fernández L, et al. Area strain from 3D speckle-tracking echocardiography as an independent predictor of early symptoms or ventricular dysfunction in asymptomatic severe mitral regurgitation with preserved ejection fraction. Int J Cardiovasc Imaging 2016;32(8):1189–98.

Murai D, Yamada S, Hayashi T, Okada K, Nishino H, Nakabachi M, et al. Relationships of left ventricular strain and strain rate to wall stress and their afterload dependency. Heart Vessels 2017;32(5):574–83.

Marciniak A, Glover K, Sharma R. Cohort profile: prevalence of valvular heart disease in community patients with suspected heart failure in UK. BMJ Open 2017;7(1):e012240.

Florescu M, Benea DC, Rimbas RC, Cerin G, Diena M, Lanzzillo G, et al. Myocardial systolic velocities and deformation assessed by speckle tracking for early detection of left ventricular dysfunction in asymptomatic patients with severe primary mitral regurgitation. Echocardiography 2012;29(3):326–33.

Thomas JD, Bonow RO. Mitral valve disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, editors. Braunwald's heart disease: A textbook of cardiovascular medicine. 11th ed. Philadelphia: Elsevier Inc, 2019; p.1415–44.

Tops LF, Delgado V, Marsan NA, Bax JJ. Myocardial strain to detect subtle left ventricular systolic dysfunction. Eur J Heart Fail 2017;19(3):307–13.

Gunjan M, Kurien S, Tyagi S. Early prediction of left ventricular systolic dysfunction in patients of asymptomatic chronic severe rheumatic mitral regurgitation using tissue Doppler and strain rate imaging. Indian Heart J 2012;64(3):245–8.


  • There are currently no refbacks.

Contact Number: +92-992-382571

email: [jamc] [@] []