Volume 4, Issue 3, September 2020, Page: 152-163
Atrial Deformation Correlated with Functional Capacity in Mitral Stenosis Patients
Monir Osman Amin, Cardiology Department, Al-Azhar University, Cairo, Egypt
Mohamed Saad Al Gammal, Cardiology Department, Al-Azhar University, Cairo, Egypt
Mohamed Said Ewais Mohamed, Cardiology Department of Mabaret misr Alkadema Hospital, Cairo, Egypt
Received: Jul. 8, 2020;       Accepted: Aug. 3, 2020;       Published: Aug. 25, 2020
DOI: 10.11648/j.ccr.20200403.21      View  96      Downloads  53
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.
Keywords
Mitral Stenosis, Left Atrium, Speckle Tracking Echocardiography
To cite this article
Monir Osman Amin, Mohamed Saad Al Gammal, Mohamed Said Ewais Mohamed, Atrial Deformation Correlated with Functional Capacity in Mitral Stenosis Patients, Cardiology and Cardiovascular Research. Vol. 4, No. 3, 2020, pp. 152-163. doi: 10.11648/j.ccr.20200403.21
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Caso P, Ancona R, Di Salvo G, et al. Atrial reservoir function by strain rate imaging in asymptomatic mitral stenosis: prognostic value at 3 year follow-up. Eur J Echocardiogr. 2009; 10: 753-759.
[2]
Saraiva RM, Demirkol S, Buakhamsri A, et al. Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr. 2010; 23: 172-180.
[3]
Tsai WC, Lee CH, Lin CC, et al. Association of left atrial strain and strain rate assessed by speckle tracking echocardiography with paroxysmal atrial fibrillation. Echocardiography. 2009; 26: 1188-1194.
[4]
Kono T, Sabbah HN, Rosman H, et al. Left atrial contribution to ventricular filling during the course of evolving heart failure. Circulation. 1992; 86: 1317-1322.
[5]
Inaba Y, Yuda S, Kobayashi N, et al. Strain rate imaging for noninvasive functional quantification of the left atrium: comparative studies in controls and patients with atrial fibrillation. J Am Soc Echocardiogr. 2005; 18: 729-736.
[6]
Kapoor A, Kumar S, Shukla A, et al. Determinants of left atrial pressure in rheumatic mitral stenosis: role of left atrial compliance and “atrial stiffness”. Indian Heart J. 2004; 56: 27-31.
[7]
Chien CY, Chen CW, Lin TK, et al. Atrial deformation correlated with functional capacity in mitral stenosis patients. Echocardiography. 2018; 35 (2): 190-195.
[8]
Demirkol S, Kucuk U, Baysan O, et al. The impact of mitral stenosis on left atrial function assessed by two-dimensional speckle tracking echocardiography. Echocardiography. 2012; 29: 1064-1070.
[9]
Guidelines and standards for Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice. Journal of the American Society of Echocardiography January 2009; Vol 22 No 1: 1-23.
[10]
Mohammed LA, Agiba NA and Aly AA. Effect of left atrial functions upon the functional capacity in patients with systolic heart failure. Al-Azhar Assiut Med J. 2019; 17: 198-206.
[11]
Reda AA, Soliman MA, Ahmed MK, et al. Assessment of left atrial function in patients with systolic heart failure: strain imaging study. Menoufia Med J. 2015; 28: 532-9.
[12]
Leung DY, Boyd A, Ng AA, et al. Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications. Am Heart J. 2008; 15: 1056-1064.
[13]
Kusunose K, Motoki H, Popovic ZB, et al. Independent association of left atrial function with exercise capacity in patients with preserved ejection fraction. Heart. 2012; 98: 1311-1317.
[14]
D’Andrea A, Caso P, Romano S, et al. Association between left atrial myocardial function and exercise capacity in patients with either idiopathic or ischemic dilated cardiomyopathy: a two-dimensional speckle strain study. Int J Cardiol. 2009; 132: 354-363.
[15]
Ahmed MK, Soliman MA, Reda AA, et al. Assessment of left atrial deformation properties by speckle tracking in patients with systolic heart failure. Egypt Heart J. 2015; 67: 199-208.
[16]
Rahimtoola SH, Enriquee-Sarano M, Schaff HV, Frye RL, Mitral valve disease; mitral stenosis. Hurst’s The Heart. International edition. McGraw-Hill, Health Professional Division. 1998; Vol. 2, P 1789-1799.
[17]
Bianca Moise, Monica Rosca, Dragos Alexandru, Carmen Ginghina, Left atrial remodeling in patients with mitral stenosis. Romanian Journal of Cardiology 2017; Vol. 27, No. 2: 175-176.
Browse journals by subject