Evaluation of Left Atrial and Ventricular Function at Rest and
Post-exercise by Speckle Tracking in Patients with Mild Mitral Stenosis
Abstract
Rheumatic mitral stenosis is a leading cause of morbidity in developing
countries. Symptomatic patients with mitral valve area>1.5
cm2 comprises a gray zone in management. Exercise stress testing is
recommended in these patients with symptoms discordant with the severity
of the stenosis. Left atrial strain analysis with speckle tracking
imaging emerges as a promising technique for the evaluation of
haemodynamics better. The aim of our study is to examine the left atrial
and ventricular function both during rest and just after exercise by
speckle tracking imaging in patients with mild rheumatic mitral stenosis
and ascertain early hemodynamic deterioration. We included 46 patients
with mild mitral stenosis (mitral valve area>1.5 cm2) The
patients were evaluated with comprehensive 2D and Doppler
echocardiography during rest, before the exercise stress test. Left
atrial and ventricular peak systolic strain values were calculated by
using a software program. Exercise stress test was then performed by
using treadmill with standard Bruce protocol. Immediately after the
termination of the test, the echocardiographic examination was repeated.
Both mean trans-mitral gradient and systolic pulmonary artery pressure
values were higher following exercise (p<0.001, p=0.001,
respectively). Exercise did not cause a significant chance in left
atrial and ventricular peak systolic strain value (p=0.708, p=0.854). A
negative significant correlation was found between the mean trans-mitral
gradient and peak systolic left atrial strain following exercise. In
patients with mitral valve area>1.5 cm2, exercise stress
test did not cause a significant change in left atrial and ventricular
peak systolic strain.