Role of Two Dimension Strain and Strain Rate Echocardiography in Assessment of Rheumatic Mitral Valve Stenosis

Abstract

Introduction: Current echocardiographic parameters have a limitation in assessing mitral valve (MV)apparatus in rheumatic mitral stenosis (MS) patient. In the current study, we use 2 dimensional (2D)longitudinal strain (S) and strain rate (Sr) imaging in evaluating the papillary muscle longitudinal strain (LS) as an objective and quantitative echocardiographic parameter with high reproducibility in the assessment of MV apparatus in patients with mild to moderate rheumatic MS with preserved ejection fraction (EF%). Patients and Method: The study included 40 patients with established diagnosis of MS subdivided in to 31 patients with moderate MS (mean age: 32 ± 5) and 9 patients with mild MS (mean age: 31 ± 6). 20 healthy individuals (mean age 31 ± 6) as a control for cases. The mitral valve area (MVA) was estimated using planimetry and pressure half time (PHT) methods. 2D longitudinal systolic S and Sr imaging was carried out for all participants from the apical long axis (LAX), 4 chamber (4C), 2 chamber (2C) views. Global longitudinal systolic S and Sr were estimated by averaging the 3 apical views. Longitudinal myocardial strain of papillary muscle PMs was assessed by the use of the free strain method from apical 4 chamber view for the antrolateral papillary muscle (APM) and apical long axis view for postromedial papillary muscle (PPM). Results: Patients with MS had significantly decreased longitudinal LV systolic S and Sr in comparison with control group (p Conclusion: Patients with MS and preserved EF% had decreased APM-LS & PPM-LS in comparison with control group, and had decreased longitudinal LV systolic S and Sr when compared with control group. 2D strain as well as Sr imaging might be a useful method for assessment of mitral valve apparatus in patients with MS & preserved EF%.