Background: In developing countries, rheumatic mitral valve stenosis (MS) is still a problem and its progression leads to left atrial (LA) damage. Due to the complexity of the LA geometry, currently used techniques like antero-posterior dimension (LAD) and 2D echo derived LA volume (LAV) have several limitations that are corrected by 3D derived LA volumes in addition to functional evaluation.
Purpose: To assess the LA functions using 2D speckle tracking echocardiography and 3D transthoracic echocardiography in patients with clinically significant MS in comparison to normal healthy subjects.
Results: Fifty patients and 50 healthy controls were studied. Patients' mean age was 40.2 ± 8.8 years, the majority were female 45(81.8%). 3D indexed LA maximum (LAVmaxI) and minimum (LAVminI) volumes were significantly higher in MS than in the control group, whereas 3D LA EF was significantly lower in MS than in the control group (p 0.001). LA strain reservoir, conduit, and contraction parameters were significantly lower in the MS group than in the control group (p = 0.001). However, only 3D LAEF, 2D LASr, 2D LAScd, and 2D LASct showed a correlation with the mitral valve area with a p < 0.05, but 3D LAVmaxI and 3D LAVminI did not. Additionally, in the comparison of severe and very severe mitral stenosis subgroups, 3D LAVmaxI and 3D LAVminI did not show any statistically significant differences between the two groups, although 3D LAEF, 2D LASr, 2D LAScd, and 3D LASct showed significant difference between the two groups (p < 0.05).
Conclusions: Left atrial functional and structural remodelling has been highlighted in patients with significant rheumatic MS. However, left atrial functional assessment by 3D echocardiography and 2D speckle tracking echocardiography correlate better with mitral valve area than conventional LA size measurements. Whether the functional assessment of the LA has an additive predictive value with regards to patient outcome needs to be interrogated.
Keywords: Mitral stenosis; atrial myopathy; left atrial emptying fraction; left atrial strain.
What is already known on this topic – rheumatic MS is commonly encountered in developing countries. LA size changes have been well studied in MS however, LA functional changes still needed to be investigated.What this study adds – Our study assessed the functional LA remodelling in the clinically significant MS and was highly selective for patients in sinus rhythm only. This came out with significant correlation of the 3D derived LA EF and LA strain functions with the severity of MS especially the MVA.How this study might affect research, practice or policy -Inclusion of the LA functional assessment may help to identify patients who could be at risk of complications such as AF and thrombus formation and to select patients referred for MV intervention.