DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20173953

Evaluation of left and right ventricular functions pre and post balloon mitral Valvuloplasty using speckled tracking echocardiography

Pawan Mehta, Vishwa Deepak Tripathi

Abstract


Background: Rheumatic heart disease remains a considerable cause of cardiovascular morbidity and mortality in developing countries such as India. The aim of the present study was to compare ventricular (LV and RV) function in patients with severe mitral stenosis (MS) undergoing balloon mitral Valvuloplasty (BMV) with those on medical management and also with healthy controls and to assess the burden of ventricular (LV and RV) systolic dysfunction, its determinants, and its reversibility with percutaneous balloon mitral Valvuloplasty using speckle tracking echocardiography in patients with severe MS.

Methods: This prospective study was performed in a tertiary care center, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow in patients with severe MS, from September 2014 to September 2015. A total of 60 were divided into three groups. Cases (n=30), patients with severe MS undergoing BMV; case controls (n=20), patients with severe MS who did not give consent for BMV and chose medical management and healthy controls (n=10). Cases who underwent BMV were analyzed pre and post BMV and detailed echocardiographic and speckle-tracking echocardiography (STE) was done at baseline, 24-48 hours after BMV and at post one month after BMV. Appropriate statistical analysis was applied and different parameters were compared.

Results: Most of the cases (56.7%) control (65%) and healthy controls (40%) were between 21-30 years of age. Female preponderance was observed in the study. A significant (p=0.01) decrease in the LA size, PASP (p=0.0001), MV PG area (p=0.0001) and significant (p=0.0001) increase in the LVEF, MVA area was observed from baseline to post 24-48 hours and at post one month after BMV among cases. Significant improvement was noticed in longitudinal strain and regional rotation in different LV segments as assessed by STE at post 24-48 hours and post one month after BMV (p value 0.001) among cases. No significant (p>0.05) difference in the 2D echo parameters was seen from baseline to follow-ups among the case controls. No significant improvement was observed in regional rotation, global rotation in different LV and RV segments after one month as assessed by STE among case controls whereas significant improvement was seen in cases.

Conclusions: BMV results in marked improvement in LV and RV GLS immediately post BMV with improvement towards normalization at follow up after one month and the same can be easily assessed by Speckle tracking echocardiography.


Keywords


Rheumatic heart disease, Mitral stenosis, Speckle tracking echocardiography

Full Text:

PDF

References


Pastore S, De Cunto A, Benettoni A, Berton E, Taddio A, Lepore L. There surgence of rheumatic fever in a developed country area: the role of echocardiography. Rheumatol (Oxf). 2011;50:396-400.

ChandrashekharY, Westaby S, Narula J. Mitral stenosis. Lancet. 2009;374:1271-83.

Tandon R. Rheumatic fever pathogenesis: approach in research needs change. Ann Pediatr Cardiol. 2012;5:169-78.

Ozdemir O, Oguz D, Atmaca E, Sanli C, Yildirim A, Olgunturk R. Cardiac troponin T in children with acute rheumatic carditis. Pediatr Cardiol. 2011;32:55-8.

Ozer N, Can I, Atalar E, Sade E, Aksoyek S, Ovunc K, et al. Left ventricular long-axis function is reduced in patients with rheumatic mitral stenosis. Echocardiography. 2004;21:107-12.

Bilen E, Kurt M, Tanboga IH, Kaya A, Isik T, Ekinci M, et al. Severity of mitral stenosis and left ventricular mechanics: a speckle tracking study. Cardiol. 2011;119:108-15.

Burger W, Brinkies C, Illert S, Teupe C, Kneissl GD, Schrader R. Right ventricular function before and after percutaneous balloon mitral valvuloplasty. Int J Cardiol. 1997;58:7-15.

Klein A, Carroll JD. Left ventricular dysfunction and mitral stenosis. Heart Failure Clin. 2006;2:443-52.

Mohan JC, Sengupta PP, Arora R. Immediate and delayed effects of successful percutaneous transvenous mitral commissurotomy on global right ventricular function in patients with isolated mitral stenosis. Int J Cardiol. 1999;68:217-23.

Dray N, Balaguru D, Pauliks LB. Abnormal left ventricular longitudinal wall motion in rheumatic mitral stenosis before and after balloon valvuloplasty: a strain rate imaging study. Pediatr Cardiol. 2008;29:663-6.

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 Echo cardiogr. 2014;27:639-47.

Adavane S, Santhosh S, Karthikeyan S. Decrease in leftatrium volume after successful balloon mitral valvuloplasty: an echocardiographic and hemodynamic study. Echocardiography. 2011;28:154-60.

Mohan JC, Bhargava M, Agrawal R, Arora R. Effects of balloon mitral valvuloplasty on left ventricular muscle function. Int J Cardiol. 1995;49:17-24.

Mohan JC, Agrawal R,Arora R, Khalilullah M. Atrial contribution to left ventricular filling in mitral stenosis: effects of balloon mitral valvuloplasty. Indian Heart J. 1994;46:129-32.

Pan JP, Chen CY, Hsu TL, Wang SP, Chiang BN, Chang MS. Response of left ventricular ejection performance following balloon valvuloplasty in patients with mitral stenosis. Zhonghua Yi XueZaZhi (Taipei). 1992;49:303-12.

Ozdemir AO, Kaya CT, Ozdol C, Candemir B, Turhan S, et al. Two-dimensional longitudinal strain and strain rate imaging for assessing the right ventricular function in patients with mitral stenosis. Echocardiography. 2010;27:525-33.

Kumar V, Jose VJ, Pati PK, Jose J. Assessment of right ventricular strain and strain rate in patients with severe mitral stenosis before and after balloon mitral valvuloplasty. Indian Heart J. 2014;66:176-82.