Left Ventricular Mechanics in Isolated Rheumatic Mitral Stenosis ;Impact of loading condition on different parameters of left ventricular function


Atoosa Mostafavi ORCID 1 , Azin Alizadehasl ORCID 2 , * , Shahin Shirani 3

1 Department of Echocardiography, Tehran University of Medical Sciences, Dr. Ali Shariati Hospital, Tehran, IR Iran

2 Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, IR Iran

3 Cardiology Department, Tehran University of Medical Science, Shariati Hospital, Tehran, IR Iran

How to Cite: Mostafavi A, Alizadehasl A, Shirani S. Left Ventricular Mechanics in Isolated Rheumatic Mitral Stenosis ;Impact of loading condition on different parameters of left ventricular function. Int Cardio Res J. 2030;15(2):e111814.


International Cardiovascular Research Journal: 15 (2); e111814
Published Online: June 30, 2021
Article Type: Research Article
Received: December 01, 2020
Revised: May 29, 2021
Accepted: August 06, 2021


Background: Rheumatic mitral stenosis leads to depressed ventricular function, which
is not detectable through the measurement of ejection fraction. Whether pancarditis or
changes in loading condition results in subclinical Left Ventricular (LV) dysfunction has
yet to be fully elucidated.
Objectives: The aim of this study is to evaluate the effect of loading condition on left
ventricular function.
Methods: The present observational, case-control study was conducted on 104 cases who
were referred to the echocardiography department including 71 patients with different
severity degrees of rheumatic mitral stenosis and 33 healthy individuals with no past
history of cardiac or other medical illnesses and with normal echocardiography who
were matched with the cases in terms of age, gender, and body surface area. The strain,
strain rate, rotation, torsion, and twist parameters of the left ventricle were measured
via 2D speckle-tracking echocardiography. The data were analyzed using Kolmogorov–
Smirnov test, independent student t-test, and one-way Analysis of Variance (ANOVA),
as appropriated. Correlation analysis was also performed using linear regression, and
the results were expressed as Pearson’s correlation coefficients.
Results: The LV Global Longitudinal Strain (GLS), Global Longitudinal Strain Rate
(GLsr), and Global Circumferential Strain Rate (GCsr), but not Global Circumferential
Strain (GCS), basal and apical rotations, twist, and torsion, were significantly lower
in the subgroup with progressive mitral stenosis (17.7%, 1.07s-1, 22.85%, and 1.05s-1
, respectively) compared to the healthy group (19.76%, 1.17 s-1, 24.15%, and 1.27 s-1,
respectively) (P = 0.001, 0.032, 0.104, and < 0.001, respectively). Increase in the severity
degree of mitral stenosis was accompanied by a significant decrease in the mentioned
Conclusions: The rheumatic process led to a reduction in ventricular function, which
was detectable through the measurement of the GLS, GLsr, and GCsr, but not GCS, twist,
rotation, and torsional parameters of the left ventricle. As the severity of the stenosis
progressed, other indices of the LV function such as rotation, twist, and torsion decreased
significantly, indicating their more susceptibility to loading conditions compared to the
rheumatic process per se.


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