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Archives of cardiovascular diseases
Volume 106, n° 4
page 250 (avril 2013)
Doi : 10.1016/j.acvd.2013.03.017

Tissue Doppler echocardiography for the assessment of systolic and diastolic right ventricular function in mild mitral stenosis

I. Hamdi, T. Filali, H. Mahfoudhi, B. Jdaida, M. Ghommidh, N. Hajlaoui, D. Lahidehb, W. Fehri, H. Haouala
 Hôpital Militaire de Tunis, Tunis, Tunisia 

Background .– Right ventricular (RV) function usually affects the outcome in valvular heart disease. Evaluation of RV function in patients with mild mitral stenosis an essential component of clinical management.

Purpose .– The aim of this study is to assess RV function in asymptomatic patients with mild mitral stenosis.

Method .– Thirty-two patients with mild mitral stenosis (mean mitral valve area=1.73±0.21cm2) were included in this study matched with 35 control. All of them were in sinus rhythm. The two groups had similar mean ages and sex ratio. All included subjects had no evidence of hypertension, diabetes mellitus, ischemic heart diseases or chronic pulmonary diseases. We used conventional echocardiography and tissue Doppler imaging.

Results .– We observed no difference in conventional indices of global left ventricular function between the two groups. RV ejection fraction, the conventional Tei index and the tricuspid annular plane systolic excursion were similar in both groups.

The tricuspid annulus systolic velocities obtained at the basal RV free wall were significantly reduced in patients group compared to control group (11.3±1.3cm/s vs. 14.9±1.6cm/s, P <0.01). Moreover, tricuspid annulus early diastolic velocities were significantly reduced in mild MS subjects (−7.5±1.4cm/s vs.−10.9±1.3cm/s, P <0.01) with lower ration of early to late diastolic velocities (0.7±0.15 vs. 1.24±0.18, P <0.01).

Among mild MS patients, impaired RV systolic and diastolic indices are significantly pronounced in the subgroup with mitral valve area<1.7cm2.

Conclusion .– Our data suggest the presence of subclinical systolic and diastolic RV dysfunction in pure mild mitral stenosis patients. Tricuspid annulus tissue Doppler indices were able to assess RV dysfunction and to precociously recognize patients with worse prognosis.

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