Effect of Percutaneous Balloon Mitral Valvuloplasty on Six Minute Walk Test and Left Ventricular Performance by Speckle Tracking Chocardiography in Rheumatic Severe Mitral Stenosis
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 3
Abstract
Background: The effect of percutaneous balloon mitral valvuloplasty (PBMV) on left ventricular function in patients with rheumatic severe mitral stenosis (MS) has been controversial for decades. Our aim is to study the effect of PBMV on left ventricular (LV) performance by strain imaging Methods: In this prospective study, we included 74 patients with rheumatic severe MS requiring PBMV. The echocardiographic parameters studied were left ventricular ejection fraction (LVEF), mitral annular systolic velocity (MASV), mitral annular early diastolic velocity (E'), mitral annular plane systolic excursion (MAPSE) and myocardial performance index (MPI). Strain parameters were studied by speckle tracking echocardiography. Six minute walk distance (6MWD) was measured. Results: Out of the 74 patients, 48 were females, showing a female predominance. The mean age of the study population was 33.7±8.4 years. On comparing LV parameters before PBMV and at 48 hours after PBMV, MASV (cm/s) and E' showed a significant increase at 48hours after PBMV. No significant change was observed in MAPSE, MPI and LVEF either by Teicholz method or Simpson method. The global circumferential strain (GCS) (-21.1±2.8 vs -26.2±3.6; p = 0.02) and global circumferential strain rate (GCSR) (-1.1±0.2vs -1.3±0.2; p<0.01) showed significant improvement at 48 hours after PBMV. The global longitudinal strain (GLS) (%) (-17.8±3.2 vs -18.9±3.5; p = 0.18), global longitudinal strain rate (GLSR) (1/s) (-1.3±0.1 vs -1.3±0.2; p = 0.21), global radial strain (GRS) (40.1±8.5 vs 41.5±7.2; p = 0.32) and global radial strain rate (GRSR) (1.9±0.2 vs 1.9±0.3; p = 0.26) showed no significant change at 48 hours after PBMV. However, GLS (-17.8±3.2 vs -21.2±5.6; p = 0.03) and GLSR (- 1.3±0.1 vs -1.5±0.2; p = 0.04) showed a significant improvement at 2 weeks after PBMV compared to the values before PBMV. 6MWD (m) increased significantly at 48hours after PBMV compared to pre-PBMV values (335.3±40.3 vs 394.3±52.2 ; p < 0.01). It also showed a significant improvement at 2 weeks after PBMV compared to values at 48 hours after PBMV (335.39±40.31 vs 434.3±58.6; p<0.01) . On Pearson correlation, GLS and GCS showed a significant linear correlation with mitral valve area (MVA) before PBMV. On correlating the changes in the various parameters before PBMV and at 48 hours after PBMV, ∆GLS showed a significant linear correlation with ∆MVA and ∆6MWD. ∆GCS also showed a significant linear correlation with ∆MVA and ∆6MWD. ∆GRS did not show a significant correlation with either ∆MVA or ∆6MWD. Conclusions: GLS and GCS may be more sensitive than LVEF to detect changes in the LV performance after PBMV. Patients with higher improvement in GLS and GCS after PBMV had a higher increase in 6MWD suggesting that improvement in the strain parameters after PBMV actually translated into an improvement in the functional exercise capacity of these patients.
Authors and Affiliations
Sumanth P, Rajasekhar D, Vanajakshamma V, Kiran K, Nagaraja C Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
Keywords
Related Articles
- EP ID EP557891
- DOI 10.9790/0853-1803140414.
- Views 35
- Downloads 0
Social relationship between the victims and the accused of sexual offence reported in a tertiary care setting of a metro city in India
The incidence of sexual offence against women are increasing all over the world. The factors which predispose a woman to become a victim of these incidences are multiple. Understanding these risk factors is essential to...
Roleof diffusion weighted MRI in differentiating benign versus malignant female pelvic masses and its pathological correlation
Uterine and adnexal masses have been a leading cause of morbidity and mortality in women worldwide.The role of MRI in gynaecological conditions has evolved during the past two decades, determining whether a clinically di...
Clinicohistopathology Correlation in Women Who Underwent A Hysterectomy for A Benign Condition
.
Comparative Evaluation of Co-Loading Versus Preloading For Prevention Of Post- Spinal Hypotension In Elective Caesarean Section
Aims and Objectives: The aim of the present study was to study the effectiveness of co-loading of crystalloid over preloading of crystalloid in prevention of maternal hypotension during spinal anaesthesia for elective ca...
Prevalence of Tobacco Use and Assessment of Knowledge and Attitude of School Children towards Tobacco Consumption in and Around Kanpur City
Aim: The objective of this study is to assess the knowledge, attitude and prevalence of tobacco consumption among rural and urban school children aged 12-17years.Material&Mehotds: A descriptive questionnaire cross-sectio...