Introduction
Rheumatic heart disease (RHD) is endemic in developing countries, where it remains the second most common cause of cardiovascular morbidity and mortality after atherosclerotic cardiovascular disease Mitral valve is the most commonly involved valve being afflicted in 60.2% patients, with mitral stenosis (MS) being the most common valve lesion in chronic RHD. MS causes obstruction to left ventricular (LV) diastolic filling, leading to morphological and functional changes in left atrium (LA) as a result of LA pressure overload. The elevated LA pressure is transmitted back to pulmonary circulation resulting in exertional dyspnea and ultimately leads to development of post-capillary pulmonary hypertension. LA compliance is an important determinant of LA pressure as different LA pressures are recorded in different subjects despite similar mitral valve areas (MVA).4 Chronic LA pressure overload leads to atrial muscle bundle disorganization and fibrosis resulting in both atrial stiffness and atrial reservoir dysfunction.5 The left atrial dysfunction may be detected and quantified by deformation imaging i.e. speckle tracking echocardiography (STE). STE is a reliable and effective tool for evaluating LA function.
LA dysfunction has been reported in patients with rheumatic MS.10 However most studies have either assessed global LA strain, reservoir or conduit strain values with contractile strain being reported only in mild to moderate MS.10,11 Only very limited data is available regarding all three strain parameters in patients with severe MS. In the present study we assessed LA function (reservoir, conduit strain and contractile strain) by two-dimensional speckle tracking echocardiography and its correlation with clinical symptoms and echocardiography parameters in patients with isolated severe MS with pulmonary hypertension and healthy controls.