Changes in peak left atrial longitudinal strain after percutaneous balloon mitral valvotomy and its long term impact on left atrial volumes in patients in sinus rhythm

10.5083/ejcm.20424884.112 , Cite or Link Using DOI
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Mohamed Ismail Ahmed MD


Background: The prognostic significance of left atrial (LA) size on cardiovascular outcome is now well recognised in literature. Balloon mitral valvotomy (BMV) can reduce complications and improve outcome in rheumatic patients. On long term follow up in rheumatic mitral stenosis patients after BMV, left atrial volumes were shown to decrease.

Methods: This is a prospective study that enrolled 54 patients who undergone successful BMV. Longitudinal Left atrial function was evaluated by speckle tracking derived strain. Left atrial volumes were measured before valvotomy, after the procedure and after 12 months during follow-up. The effect of transmitral pressure gradient drop after balloon mitral valvotomy on left atrial strain was studied. In addition the relation between post-procedural increase of LA strain and left atrial volumes after 12 months was also evaluated.

Results: There is significant reduction of mean trans-mitral pressure gradient from 13.104 ± 4.694 to 4.067±1.502 mmHg and significant improvement of mitral valve area from 1.0217 ±0.1178 to 1.766 ± 0.2307cms2 after the procedure (P value < 0.001). The mean peak longitudinal left atrial strain was much improved after BMV from 19.80±9.66 % to 34.39±12.86%. This difference was statistically highly significant. (P value was <0.0001). The percent improvement of left atrial longitudinal strain correlated significantly with mean trans-mitral pressure gradient drop. Also left atrial mean peak left atrial longitudinal strain correlated significantly with left atrial volumes reductions after 12 months.

Conclusions: Successful BMV results in reduction of mean left atrial volumes after 12 months which is well correlated with PALS percent change after BMV.