The Diagnostic Role of Speckle-Tracking Echocardiography–Derived Right Ventricular Longitudinal Strain in Determining the Severity of Rheumatic Mitral Stenosis

Firoozeh  Abtahi; Haleh  Esfandiari; Alireza  Arzhangzadeh; Salma  Nozhat; Roozbeh  Narimani-Javid

doi:10.18502/jthc.v20i3.20110

Firoozeh Abtahi Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran.
Haleh Esfandiari Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran.
Alireza Arzhangzadeh Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran.
Salma Nozhat Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran.
Roozbeh Narimani-Javid Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jthc.v20i3.20110

Keywords: Mitral Valve Stenosis; Speckle-Tracking Echocardiography; Global Longitudinal Strain; Free-Wall Longitudinal Strain; Right Ventricular Function

Abstract

Introduction: Echocardiographic planimetry is the primary and most available modality for diagnosing rheumatic mitral stenosis (MS). Nonetheless, this approach is highly reliant on the examiner’s technique. Echocardiographic evaluation of MS should also include assessment of right ventricular (RV) function because of its prognostic role. We hypothesized that the assessment of RV function via speckle-tracking echocardiography could also have a diagnostic role in determining MS severity.

Methods: This cross-sectional study included 47 patients with a typical diagnosis of rheumatic MS. Echocardiographic data were recorded and evaluated offline by an expert cardiologist. We measured right ventricular global longitudinal strain (RVGLS), right ventricular free-wall longitudinal strain (RVFWLS), mitral valve area (MVA) using 2D planimetry, and other conventional parameters of MS severity. Data were analyzed and visualized utilizing SPSS version 26 (IBM Corp) and Python 3.10.6 (Python Software Foundation).

Results: Our analysis showed that both RVGLS (R=–0.598; P<0.05) and RVFWLS (R=–0.620; P<0.05) were significantly correlated with MVA. The mean RVGLS values in patients with severe and progressive MS were –14.44±4.36 and –18.12±3.25, respectively (P=0.017). The mean RVFWLS values also demonstrated a significant difference between these two groups (–6.3±4.7 vs–20.8±3.2; P=0.005). The area under the curve (AUC) for RVGLS and RVFWLS in detecting severe MS was 0.75 (95% CI, 0.64 to 0.86) and 0.78 (95% CI, 0.66 to 0.90), respectively.

Conclusion: RVGLS and RVFWLS significantly correlate with MVA and may serve as tools to assess the severity of rheumatic MS in daily clinical practice. These strain parameters have high sensitivity for ruling out severe MS during routine echocardiographic evaluation.