Atrial Deformation Correlated with Functional Capacity in Mitral Stenosis Patients

Abstract

Background: Mitral stenosis (MS) is the most common valve disease seen as a sequel of rheumatic fever and usually presents with exertional dyspnea, right sided heart failure and pulmonary arterial hypertension. Aim: To determine the functional class of dyspnea in patients with MS and to investigate the relationship between Left Atrial (LA) deformation as measured by two-dimensional Speckle Tracking Echocardiography (STE)-derived LA strain and heart failure symptoms. Patients and methods: This was a prospective study carried out on 25 patients referred for evaluation of MS using echocardiography and 25 control subjects, who were evaluated using 2D and color Doppler echocardiography, including STE-derived LA strain (LAS) and peak positive filling strain rate (LASRr) during the LA reservoir phase. Those results were then correlated with New York Heart Association (NYHA) functional class. Results: There was a statistically significant difference between the patients and the control groups in the LAS in the apical 4 chamber view (LAS A4) (64.240±15.271, 40.360±21.785, respectively; p=0.001), LASRr A4 (2.504±0.358, 1.740±0.716, respectively; p=0.001) and LASRc A4 (-2.796±0.226, -1.820±0.928, respectively; p=0.001). also, there was a highly significant relation between NYHA class and LAS A4, LASRr A4 and Peak Negative Conduit Strain Rate (LASRc A4), with P<0.001 with all data. Conclusion: This study showed that all left atrial (LA) reservoir, conduit and contractile functions showed prominent impairment in mitral stenosis patients. Speckle tracking strain and strain rate were useful in pointing out the different effects of MS on left atrial functions. The assessment of LA dimension and function can provide further insights in patients with MS, LA dimension and volume in patients with MS had a positive significant correlation with NYHA classes (heart failure symptoms). In stable patients (NYHA classes I & II) with MS, NYHA functional class independently correlated with LAS and LASRr as LAS and LASRr values of stable patients and control aspects were normal. While LA deformation (LAS and LASRr) was significantly correlated with heart failure symptoms (NYHA Classes III & IV) in patients with MS.