SUBCLINICAL LEFT VENTRICULAR DYSFUNCTION IN PATIENTS WITH ISOLATED SEVERE RHEUMATIC MITRAL STENOSIS HAVING NORMAL LEFT VENTRICULAR EJECTION FRACTION
AbstractBackground: Mitral stenosis (MS) is a prevalent disease in the developing world. It is a preventable disease associated with considerably high morbidity and mortality rates. Myocarditis secondary to rheumatic MS can cause left ventricular (LV) dysfunction. In majority of the case this LV dysfunction is subclinical. Recent development in imaging techniques like tissue Doppler imaging (TDI) and strain imaging enabled us to detect subclinical LV dysfunction. One such example is Global Longitudinal Strain (GLS), which is a reliable mean of assessing LV dysfunction in patients diagnosed with mitral stenosis. Objective of the study was to determine frequency of subclinical LV dysfunction by mean GLS in patients with isolated severe Rheumatic MS having normal LV Ejection fraction measured by 2D/M-mode echocardiography. Methods: It was an observational cross-sectional study, conducted at Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, during the period of six months from 1st January to 30th June 2016. Fifty-five patients with isolated severe mitral stenosis of underlying rheumatic aetiology with preserve LV function (EF>50%) were selected as per other inclusion and exclusion criteria. All patients were evaluated with detailed history, physical examination and echocardiographic examination. GLS was also noted and all other information was recorded on data collection form. Results: The average age and mean GLS was 48.20±11.62 years and -19.24±1.15% respectively. Left ventricular systolic impairment in patients under study using the Global Longitudinal Strain was seen in 16.36% (9/55) cases. Conclusion: Our results suggest that GLS helps in detecting impairment of LV systolic function at an early stage in patients with mitral stenosis which helps in their risk stratification thus warranting their early managementKeywords: Mitral stenosis; Subclinical LV dysfunction; GLS; Severe Rheumatic
Saxena A. Catheter interventions for mitral stenosis in children: results and perspectives. World J Pediatr Congenit Heart Surg 2015;6(2):250–6.
Ahmad S, Hayat U, Naz H. Frequency of severe mitral stenosis in young female patients having pure mitral stenosis secondary to rheumatic heart disease. J Ayub Med Coll Abbottabad 2010;22(4):19–22.
Ozdemir AO, Kaya CT, Ozcan OU, Ozdol C, Candemir B, Turhan S, et al. Prediction of subclinical left ventricular dysfunction with longitudinal two-dimensional strain and strain rate imaging in patients with mitral stenosis. Int J Cardiovasc Imaging 2010;26(4):397–404.
Lee YS, Lee CP. Ultrastructural pathological study of left ventricular myocardium in patients with isolated mitral stenosis with normal or abnormal left ventricular function. Jpn Heart J 1990;31(4):435–48.
Flores-Marín A, Gómez-Doblas JJ, Caballero-Borrego J, Cabrera-Bueno F, Rodríguez-Bailón I, Melero JM, et al. Long-term predictors of mortality and functional recovery after aortic valve replacement for severe aortic stenosis with left ventricular dysfunction. Rev Esp Cardiol 2010;63(1):36–45.
Yıldırımtürk Ö, Helvacıoğlu FF, Tayyareci Y, Yurdakul S, Aytekin S. Subclinical left ventricular systolic dysfunction in patients with mild-to-moderate rheumatic mitral stenosis and normal left ventricular ejection fraction: an observational study. Anadolu Kardiyol Derg 2013;13(4):328–36.
Yingchoncharoen T, Agarwal S, Popović ZB, Marwick TH. Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiogr 2013;26(2):185–91.
Simşek Z, Karakelleoğlu S, Gündoğdu F, Aksakal E, Sevimli S, Arslan S, et al. Evaluation of left ventricular function with strain/strain rate imaging in patients with rheumatic mitral stenosis. Anadolu Kardiyol Derg 2010;10(4):328–33.
Roushdy AM, Raafat SS, Shams KA, El-Sayed MH. Immediate and short-term effect of balloon mitral valvuloplasty on global and regional biventricular function: a two-dimensional strain echocardiographic study. Eur Heart J Cardiovasc Imaging 2016;17(3):316–25.
Younan H. Role of two-dimensional strain and strain rate imaging in assessment of left ventricular systolic function in patients with rheumatic mitral stenosis and normal ejection fraction. Egyptian Heart J 2014;67(3):193–8.
Gul AM, Hafizullah M, Zaib S, Shah I, Ali N, Ali J, et al. Left ventricular systolic dysfunction as a surrogate for Rheumatic mycarditis in patients with isolated Rheumatic Mitral Stenosis. Pak Heart J 2013;46(4):273–7.
Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet 2009;374(9697):1271–83.
Lawrence JG, Carapetis JR, Griffiths K, Edwards K, Condon JR. Acute rheumatic fever and rheumatic heart disease: incidenceand progression in the Northern Territory of Australia, 1997 to 2010. Circulation 2013;128(5):492–501.
Tadele H, Mekonnen W, Tefera E. Rheumatic mitral stenosis in children: more accelerated course in sub-Saharan patients. BMC Cardiovasc Disord 2013;13:95.
Alyan O, Metin F, Kaçmaz F, Özdemir O, Maden O, Topaloğlu S, et al. High levels of high sensitivity C-reactive protein predict the progression of chronic rheumatic mitral stenosis. J Thromb Thrombolysis 2009;28(1):63–9.
Antonini-Canterin F, Moura LM, Enache R, Leiballi E, Pavan D, Piazza R, et al. Effect of hydroxymethylglutaryl coenzyme-a reductase inhibitors on the long-term progression of rheumatic mitral valve disease. Circulation 2010;121(19):2130–6.
Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging 2009;2(5):356–64.
Motoki H, Borowski AG, Shrestha K, Troughton RW, Tang WH, Thomas JD, et al. Incremental prognostic value of assessing left ventricular myocardial mechanics in patients with chronic systolic heart failure. J Am Coll Cardiol 2012;60(20):2074–81.
Roberts WC, Virmani R. Aschoff bodies at necropsy in valvular heart disease. Evidence from an analysis of 543 patients over 14 years of age that rheumatic heart disease, at least anatomically, is a disease of the mitral valve. Circulation 1978;57(4):803–7.
Devereux RB, Jones EC, Roman MJ, Howard BV, Fabsitz RR, Liu JE, et al. Prevalence and correlates of mitral valve prolapse in a population-based sample of American Indians: the Strong Heart Study. Am J Med 2001;111(9):679–85.
Sengupta SP, Amaki M, Bansal M, Fulwani M, Washimkar S, Hofstra L, et al. Effects of percutaneous balloon mitral valvuloplasty on left ventricular deformation in patients with isolated severe mitral stenosis: a speckle-tracking strain echocardiographic study. J Am Soc Echocardiogr 2014;27(6):639–47.
Dogan S, Aydin M, Gursurer M, Dursun A, Onuk T, Madak H. Prediction of subclinical left ventricular dysfunction with strain rate imaging in patients with mild to moderate rheumatic mitral stenosis. J Am Soc Echocardiogr 2006;19(3):243–8.