Study of left ventricular torsion in patients with rheumatic mitral stenosis before and after successful balloon mitral valvuloplasty

Abstract

The study included 31 consecutive patients who were candidates for BMV. Mean age was 30.4±7.3 years, 20 patients were females and all patients were in sinus rhythm. The mean height was 1.66±0.1 meters and mean weight was 68.1±10.5 and body mass index (BMI) was 24.76±2.97 kg/m2. Basal Ejection fraction was 62.6±5.4%, basal fractional shortening was 31.9±4.1%. 11 (35%) patients had only mild mitral regurgitation (MR), while 20 (65%) patients had no MR. Eighteen (58%) patients had mild tricuspid regurgitation (TR), 3(10%) had moderate TR, and 1 (3.2%) had severe TR, while 9 (29%) patients had no TR. As for the echocardiographic scoring of MS, the mean Wilkin’s echo score was 7.39±0.84 (Mobility: 2±0.26, Thickness: 1.94±0.36, Calcification: 1.52±0.57, Subvalvular affection: 1.94±0.25), while the mean Rifaie echo score was 3.06±0.73 (Calcification: 1.45±0.57, Subvalvular: 1.61±0.5) Mitral valve area measured by the 2-D planimetry before BMV was 1.05±0.17 cm2, which increased significantly after BMV (2.34±0.25 cm2, p<0.001). Mean mitral pressure gradient was 14.9±4.3 mmHg, which decreased significantly after BMV (5.5±2.2, p<0.001). Before BMV, left atrial pressure (LAP), systolic pulmonary artery pressure (PAPs), systolic right ventricular pressure (RVPs), left ventricular end diastolic pressure (LVEDP), difference between LAP and LVEDP, and mean aortic pressure were 27.6±11, 43.2±16.7, 49.4±23.9, 10.23±2.74, 17.6±11, and 102.8±9.2 mmHg respectively. After BMV, significant reduction occurred for LAP (14.2±5.7 mmHg, p<0.001,), PAPs (25.1±8.6 mmHg, p<0.001) difference between LAP and LVEDP (–0.4±5.7 mmHg, p<0.001) and RVPs after BMV (30±13 mmHg, p<0.001,), while mean aortic pressure did not significantly change after BMV (99.5±8.8, p=0.153). Surprisingly, LVEDP increased significantly after BMV (14.62±2.87 mmHg, p<0.001) suggestive of transient LV diastolic dysfunction. Before BMV, apical rotation was 6.7±2.7 degrees, apical rotational velocity was 54.6±12.9 degree/second, basal rotation was – 5.2±1.9 degrees, basal rotational velocity was –53.3±26.6 degree/second, peak LV systolic torsion was 11.2±2.3 degrees, and torsional velocity was 82.6±16.2 degree/second. After BMV apical rotation and rotational velocity decreased significantly (5.2±1.5 degrees, 45.8±11.8 degree/second, p=0.012, 0.007) while basal rotation and rotational velocity showed a statistically non-significant decrease (–4.4±2.1 degrees, –45.5±21.1 degree/second, p=0.103, 0.206). Finally torsion and torsional velocity showed a significant decrease after BMV (9.7±2 degrees, 69.5±13.1 degree/second, p=0.012, 0.001).