Role of Speckle Tracking in Early Prediction of Right Ventricular Affection in patients with Rheumatic Mitral Stenosis

Background: In patients with rheumatic mitral stenosis (MS), speckle tracking echocardiography was tested for its ability to detect RV dysfunction early. In this patient group, RV global longitudinal strain (RV GLS) outperforms standard echocardiographic markers as a sensitive & specific diagnostic of RV dysfunction. These results may help diagnose RV involvement sooner & intervene faster in rheumatic MS patients. Patients & Methods: This study included 24 patients with mild MS & another 24 patients with moderate MS. All patients underwent a comprehensive history & physical examination, as well as echocardiography, to assess right ventricular function. Results: Tricuspid annular plane systolic excursion, (TAPSE), Fractional Area Change (FAC), right ventricular index of myocardial performance (RIMP), & S' wave indicated no difference in mild & moderate mitral stenosis systolic right ventricular (RV) function, while RV GLS & RV FWLS were considerably less negative in moderate MS patients (p<0.001). Mild & moderate mitral stenosis diastolic RV function revealed no change in E/A ratio, E/e' ratio, or IVC size, however moderate MS had a considerably reduced deceleration time (p=0.006). Mitral valve area (MVA) correlated directly with dec T & indirectly with RVGLS & RVFWLS. Receiver operating characteristic (ROC) curve study assessed right ventricular (RV) strain parameters' RV dysfunction diagnostic performance in rheumatic mitral stenosis patients. We measured RV global longitudinal strain (RV GLS) & RV free wall longitudinal strain. Global longitudinal strain (GLS) had high diagnostic accuracy, with an area under curve (AUC) of 0.92 (95% CI: 0.87-0.97, p<0.001). RV GLS's best cutoff value was -18.3%, resulting in 86% sensitivity & 88% specificity. PPV & NPV were 81% (95% CI: 73%-89%) & 79% (71%-87%) at this threshold. Conclusion: RV GLS is a sensitive & specific measure of RV dysfunction in rheumatic MS patients, exceeding echocardiographic markers. These data show that RV strain imaging in regular echocardiographic evaluation of MS patients may enhance early prediction of RV dysfunction.