Effect of percutaneous mitral balloon valvuloplasty on right ventricular functions in mitral stenosis: short- and mid-term results

Subclinical right ventricular dysfunction in patients with mitral stenosis

BACKGROUND

Right ventricular (RV) dysfunction is a strong predictor of poor outcomes of patients with mitral stenosis (MS). The aim of this study was to detect a subclinical right ventricular dysfunction in patients with MS.

METHODS

We conducted a prospective study from January 2015 to June 2019 in 104 asymptomatic patients with MS (mean age: 46.1 ± 4.27 years), and compared to a group of 52 age and sex matched healthy subjects. Standard and speckle tracking echocardiography were performed; parameters of RV function were measured and compared.

RESULTS

Although they were in normal range, RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler and pulsed wave Doppler RV myocardial performance index (MPI) and peak systolic velocity (S') were decreased in patients with MS (p < 0.05). The global RV longitudinal strain (LSGRV) and the longitudinal strain of the free wall of the right ventricular (LSFRV) were lower in patients with MS (p, respectively, at 0.001 and < 0.001), 53.5% (n = 47) of patients had LSFRV < - 20%. A significant difference was noted between LSFRV and 2D strain of the septal wall (p = 0.002). No difference was found between patients with severe MS and moderate MS regarding LSFRV and LSGRV. No correlation between LSFRV and FAC (p = 0.85), MPI (p = 0.62), TAPSE (p = 0.31) and S' (p = 0.78) was found.

CONCLUSION

Our study showed the presence of subclinical systolic dysfunction of the right ventricle in patients with MS.

Using Tissue Doppler and Speckle Tracking Echocardiography to Assess if Ivabradine Improves Right Ventricular Function

Objective

To evaluate the mid-term effects of ivabradine on right ventricular functions in patients with heart failure.

Methods

A prospective study was conducted on 52 patients who had heart failure in normal sinus rhythm (59% male, age: 64.76 ±12.49 years). Right ventricular functions were measured at baseline, after one month and one year by conventional and tissue Doppler echocardiography imaging. The parameters, right ventricular (RV) longitudinal strain (LS), RV systolic longitudinal strain rate (LSRs), RV early diastolic longitudinal strain rate, and late diastolic longitudinal strain rate, were evaluated by apical four-chamber grayscale imaging through the free wall of RV in accordance with the automated function imaging protocol.

Results

During the follow-up, the pulmonary artery systolic pressure (PASP), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI), E peak, and A peak values were similar to the basal values. While comparing the basal values of the global longitudinal systolic strain (GLS), LS, LSRs, longitudinal strain rate diastolic early filling (LSRe), and longitudinal strain rate diastolic late filling (LSRa), there were no differences in the first month but a significant increase was observed on one-year follow-up (p<0.001).

Conclusion

At the one-year follow-up, the heart failure patients who were given ivabradine treatment showed an improvement in the right ventricular function assessed by the new echocardiographic techniques.

Immediate impact of successful percutaneous balloon mitral valvuloplasty on right and left ventricular functions: An echocardiographic study using load independent tissue velocity imaging indices

Background

The impact of successful percutaneous balloon mitral valvuloplasty (PBMV) on left ventricular (LV) function has been a controversial subject. This study aimed to determine the immediate impact of PBMV on biventricular function using recent Tissue Velocity Imaging (TVI) derived load-independent indices.

Methods and results

A total of 30 patients with severe mitral stenosis (MS) who underwent PBMV at a tertiary center of India from August 2012 to December 2013 were included in the study. Thirty age-matched and gender-matched healthy controls were also enrolled.

Out of 30 patients, 27(90%) were female. Mean mitral valve area (MVA) of patients before and after PBMV was 0.78 and 1.82 cm² (p < 0.001), respectively. All TVI-derived LV and RV basal systolic (IVCV, Sm and the relatively load independent IVA) and diastolic velocities (Em, Em/Am) were significantly decreased in patients with MS compared to controls (p < 0.001 for all) which improved significantly after PBMV (6.4 ± 0.7 vs 11 ± 1.6; 5.8 ± 0.7 vs 9.9 ± 1.6; 1.5 ± 0.3 vs 4.2 ± 0.6; 6.4 ± 0.6 vs 13.1 ± 2.1; 0.7 ± 0.1 vs 1.7 ± 0.2 for mitral annulus respectively, p < 0.001 for all). Increment in MVA positively correlated with Tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular Sm and isovolumic contraction velocity (IVCV) and inversely with left atrium (LA) size and Pulmonary arterial systolic pressure (PASP) (p = 0.01 for LA size; p < 0.001 for others) while no such correlation was found with mitral annulus isovolumic acceleration (IVA) (r = −0.078; p = 0.679).

Conclusion

The improved right ventricular (RV) function appears to be predominantly due to afterload reduction, while that of LV appears to be more due to the acute relief of mechanical restraint.

The impact of cardiac rhythm on the mitral valve area and gradient in patients with mitral stenosis

OBJECTIVE

The aim of this study was to evaluate the effect of cardiac rhythm on the echocardiographic mitral valve area (MVA) and transmitral gradient calculation in relation to net atrioventricular compliance (Cn).

METHODS

Patients (n=22) with mild or moderate pure rheumatic mitral stenosis (MS) (MVA <2 cm2 and MVA >1 cm2) and atrial fibrillation (AF) were evaluated. All patients underwent transthoracic electrical DC cardioversion under amiodarone treatment. Nineteen of the 22 patients were successfully converted to sinus rhythm (SR). The patients were evaluated with transthoracic echocardiography before and two to three days after DC cardioversion. In order to deal with variable R-R intervals, the measurements were averaged on five to eight consecutive beats in AF. Cn was calculated with a previously validated equation [Cn (mL/mm Hg)=1.270 x MVA/E-wave downslope]. The Cn difference between AF and SR was calculated as follows: [(AF Cn-SR Cn)/AF Cn] x 100. The percentage gradient (mean or maximal) difference between AF and SR was calculated as follows: [AF gradient (mean or maximal) - SR gradient (mean or maximal)]/[AF gradient (mean or maximal)] x 100.

RESULTS

The MVA was lower (MVA planimetric; 1.62±0.29 vs. 1.54±0.27; p=.003, MVA PHT; 1.66±0.30 vs. 1.59±0.26; p=0.01) but transmitral gradient (mean gradient; 6.49±2.51 vs. 8.89±3.52; p=0.001, maximal gradient: 16.94±5.11 vs. 18.57±4.54; p=0.01) and Cn values (5.37±0.77 vs. 6.26±0.64; p<0.001) were higher in the AF than SR. There was a significant correlation between Cn difference and transmitral gradient difference (mean and maximal) (Cn difference-mean gradient difference; r=0.46; p=0.05; Cn difference-maximal gradient difference; r=0.72; p=0.001).

CONCLUSION

Cardiac rhythm has a significant impact on echocardiographic evaluation of MVA, transmitral gradient, and Cn in patients with MS.