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The Assessment of Right Ventricular Longitudinal Strain in Patients with Mitral Stenosis

Anna F Rahimah*, Amiliana M Soesanto, Rina Ariani, Estu Rudiktyo, Ario Soeryo Kuncoro

Early detection of Right Ventricular (RV) failure is particularly important in managing patient with MS, due to its significant role in clinical symptoms and prognosis of MS. One of the new developed methods for quantifying RV function is Right Ventricular Longitudinal Strain (RVLS) analysis. This study aims to assess RV function in patients with mitral stenosis by strain analysis, and also to evaluate the correlation between echocardiographic findings and right ventricular dysfunction. Conventional echocardiography and two-dimensional RVLS were performed in 50 MS patients (mean age of 39 ± 8 years) and 35 age-matched healthy control subjects (mean age of 36 ± 10 years). Right ventricular longitudinal strain was calculated as the percentage of systolic shortening of the RV free wall from base to apex in the RV-focused four-chamber view. Patients in this study were patients with isolated severe MS, with Mitral Valve Area (MVA) 0.73 ± 0.16 cm and mean Mitral Valve Gradient (MVG) 13.40 ± 3.74 mmHg. Compared with 2 the control group 2D RVLS was lower in population with MS (-18.29 ± 6.75 vs. -31.31 ± 5.24). There was a moderate correlation between RVLS and Tricuspid Annular Plane Systolic Excursion (TAPSE). Additionally, there was a moderate correlation between RVLS and Tricuspid Regurgitation Velocity (TRV) max, Tricuspid Valve Gradient (TVG), and Pulmonary Acceleration Time (PAcT). There was poor correlation between RVLS and MVA but no correlation between RVLS and mean MVG. Our study demonstrated that patients with MS had lower RV function using 2D RV longitudinal strain. Impaired RV function in these patients is more likely due to the increase in RV afterload and pulmonary hypertension