Unmasking right ventricular dysfunction in chronic rheumatic mitral regurgitation

Aims: Right ventricular (RV) systolic function is an important predictor of mortality but has been poorly studied in chronic rheumatic mitral regurgitation (CRMR). We studied RV systolic function using speckle-tracking echocardiography (STE) in patients with CRMR. Methods: Seventy-seven patients with CRMR and 40 healthy controls were enrolled in a cross-sectional study at Chris Hani Baragwanath Hospital between January and October 2014. RV peak systolic strain (PSS) and left ventricular (LV) global longitudinal strain (GI S) were measured using Philips Qlab 9 STE software. Results: RVPSS was lower in CRMR patients compared to the controls (-16.8 +/- 4.5 vs -19.2 +/- 3.4%. p = 0.003) with no difference in conventional RV systolic function parameters (p = 0.39). RVPSS was lower in severe CRMR compared to moderate CRMR patients (-14.3 +/- 4.23 vs -18 +/- 4.18%. p < 0.0001). CRMR patients with LV systolic dysfunction had a greater reduction in RVPSS and LVGLS compared to those with preserved LV systolic function (p = 0.001). LVGLS and significant tricuspid regurgitation (TR) were independent predictors of RVPSS (p < 0.001). Conclusion: In CRMR patients, RVPSS was a more sensitive marker for detecting earlier RV systolic dysfunction than traditional RV functional parameters.