Decreased Systolic Left Atrial Strain Measures Correlate With the Valve Area Among Patients With Severe Mitral Stenosis

Rheumatic heart disease is the main cause of mitral stenosis in developing countries. The assessments of left atrial deformation have yielded promising results in the evaluation of atrial function and the prediction of the long-term outcomes of many cardiac diseases. In this study, we sought to assess peak left atrial longitudinal strain (PALS) measures in patients with severe rheumatic mitral stenosis and to evaluate its variations regarding different valve areas.

Patients with severe symptomatic rheumatic mitral stenosis were recruited for the study. Mitral valve planimetry was performed via 3D evaluations using the multiplanar reconstruction method. PALS was measured by speckle-tracking echocardiography.

Eighty-four patients were enrolled in the study. The mean PALS was 11.18 ± 6.40% among the patients. The PALS measures were significantly higher in the patients in the sinus rhythm than in the group with atrial fibrillation (12.32 ± 6.38% vs 9.04± 5.74%; P = 0.03). The left atrial strain measures had a significant correlation with the mitral valve area and a significant reverse correlation with the left atrial volume index (r = 0.3, P = 0.08 and r = 0.28, P = 0.02, respectively). No significant difference was demonstrated in the PALS measures between the patients with the Wilkin score of 8 or less (32%, 25 patients) and those with the Wilkin score of 9 or more (67%, 55 patients).

Peak systolic left atrial strain was severely reduced in our patients with severe mitral stenosis. The severity of longitudinal strain impairment correlated with the valve area; however, it did not have a significant relationship with the Wilkin score of the valve. (Iranian Heart Journal 2020; 21(2): 21-26)