Assessment of Right Ventricular Mechanics in Patients with Mitral Stenosis by Two-Dimensional Deformation Imaging

Background: It is well known that right ventricular (RV) dysfunction occurs early before clinical systemic congestion in patients with mitral stenosis (MS). Therefore, we aimed to evaluate the role of two-dimensional (2D) strain imaging in the assessment of subclinical RV dysfunction. Methods: Fifty-nine patients with isolated MS (mild and moderate) and 31 healthy control subjects constituted the study population. RV peak longitudinal strain (RV-LS) and strain rate (RV-LSr) measurements were obtained from apical four-chamber view. Results: There were no significant differences in left ventricular ejection fraction (LV-EF) and RV fractional area change between control and MS groups. RV strain (23.5 +/- 7.2 vs. 18.63 +/- 6.3, P = 0.001) and RV strain rate (1.72 +/- 0.54 vs. 1.37 +/- 0.66, P = 0.01) measurements were significantly lower in patients with MS than the control group. However, RV strain and strain rate measurements were comparable between MS subgroups. Correlation analysis revealed that there was poor correlation between RV-LS/LSr and mean-maximum gradients and echoscore but moderate correlation between RV-LS and RV-Sr in systolic pulmonary artery pressure and planimetric mitral valve area. Conclusion: We demonstrated that patients with MS had lower RV functions using 2D strain imaging and this is independent from severity of MS. In the detection of subclinical RV dysfunction in patients with MS, 2D strain imaging appears to be useful. (Echocardiography, 2012;00:16)