Title : Determination of significant change in right ventricular strain among patients with rheumatic mitral stenosis after percutaneous transvenous mitral commissurotomy
Abstract:
INTRODUCTION: Application of strain echocardiography in Rheumatic Mitral Stenosis (MS) allows new insight in evaluation of cardiac function. The aim of this paper is to describe the significant change in right ventricular (RV) strain among patients with Rheumatic MS after Percutaneous Transvenous Mitral Commissurotomy (PTMC).
METHODS: This prospective cohort study was conducted between July 2023 to November 2024 in a tertiary hospital. Participants are adult Filipinos aged 19 years old and above with Severe Rheumatic MS who underwent PTMC from July 2023 to November 2023. Participants were followed up one year after PTMC. Applications of RV strain were done on 2D Transthoracic Echocardiogram before PTMC, one day post -PTMC and one year post-PTMC thru 2D speckle tracking using Siemens echocardiography machine. The RV strain and echocardiographic parameters were reviewed by an echocardiographer level III consultant blinded with clinical data and results . Paired Sample T-test, Wilcoxon Sign rank test, and McNemar test were used to determine differences between outcomes pre- and postprocedurally.
RESULTS: A total of 18 adult Filipino female patients were analyzed. Based on NYHA classification, majority (88.89%,n=16/18) were classified as class II, with the remainder (11.11%,n=2/18) in class I. The global longitudinal RV strain improved from -13.99±3.04% pre-PTMC to
-16.36±3.35% on day one post–PTMC(p<0.001) and -18.79±4.56% at one year post- PTMC(p<0.001). Free wall strain showed improvement one year post–PTMC
(-22.27±6.19%, p=0.001). Segmental RV strain analysis also showed significant improvement at one year post-PTMC in the lateral apex (-21.43±10. 01%, p=0.008), lateral mid (-21.51+ 8.80 %, p=0.004 ) and septal base (-17.78± 4.82 %, p=0.019) .
CONCLUSION: Right ventricular strain analysis revealed significant enhancements following PTMC . Significant improvements in global and segmental RV strain showed right ventricular functional recovery . These findings advocate the applications of RV strain as an additional parameter for right ventricular assessment of patient with rheumatic MS before and after PTMC .
KEYWORDS: Severe Mitral stenosis, Percutaneous Transvenous Mitral Commissurotomy, Right ventricular longitudinal strain
