Background
Rheumatic mitral valve (MV) stenosis is associated with progressive left atrial (LA) fibrosis and functional impairment, pulmonary artery systolic hypertension (PASP) and eventual right ventricular (RV) dysfunction. The study aimed to determine if LA mechanical function as assessed by speckle tracking echocardiography could identify those with increased PASP, atrial fibrillation (AFib) and RV dysfunction.
Method(s)
Patients with severe MV stenosis were identified from the institutional echo database. Echocardiograms were read off line included atrial and ventricular strain. Patients were divided into tertiles of left atrial reservoir strain (LASr) values, and data were compared and contrasted between the groups.
Result(s)
97 patients, 67 females, mean age 47.4±11.9 years, had MV mean gradient of 8.3±5.1 mmHg, MV area by pressure half time (PHT) of 1.3±0.3 cm2 and LASr of 11.18±6.4%. Those patients in the lowest LASr tertile, had the highest likelihood of AFib (72%, p=0.0001), PASP >50 mm Hg (39%, p=0.005) and worst RV impairment. In multivariable logistic regression analysis LASr, age, mean MV gradient were independent predictors of AFib and PASP >50 mm Hg. Cut-offs, determined by ROC curve analysis had high specificity for the composite outcome of Afib and PASP>50 mmHg (85% for LASr <7.7%).
Conclusion(s)
In severe MV stenosis LASr, age and mean MV gradient, are independent predictors of Afib and PASP >50 mmHg. LASr < 7.7% has high sensitivity and specificity in identifying those who meet ESC guideline 2017 criteria for valve intervention, suggesting its potentially helpful addendum to the surveillance of patients with MV stenosis.

In Severe Mitral stenosis, Left Atrial mechanics helps identify those meeting guideline criteria for intervention

ECHO ASIA is organized by Asian-Pacific Association of Echocardiography (AAE). The meeting combines the basic echocardiography training curriculum and the state-of-the-art lectures/scientific sessions provided by international as well as Asian-Pacific experts. The meeting is a unique forum where scientists from many countries in the Asian-Pacific region who are involved in the field of Doppler echocardiography gather together to exchange knowledge and skills. Various internationally distinguished faculties consent to present their findings and reveal their clinical experiences in ECHO ASIA.