title: Assessment of right ventricular strain and strain rate in patients with severe mitral stenosis before and after balloon mitral valvuloplasty.
abstract: OBJECTIVE
  Right ventricular (RV) dysfunction in isolated severe mitral stenosis (MS) patients have prognostic significance. Study aim was to assess RV function in these subjects by strain and strain rate analysis, pre and post-balloon mitral valvuloplasty (BMV).
  
  
  METHODS
  Twenty five patients with isolated severe MS in sinus rhythm were assessed for RV function by two dimensional (2D) longitudinal strain & strain rate imaging before and after BMV and compared with that from twelve healthy age matched controls.
  
  
  RESULTS
  Patients with severe MS had significantly lower global RV systolic strain; segmental strain at basal, mid, apical septum and basal RV free wall; but similar strain at mid and apical RV free wall as compared to controls. The systolic strain rate was significantly lower only at mid septum. In addition, they had higher estimated pulmonary artery systolic pressure and RV myocardial performance index; lower tricuspid annular plane systolic excursion (TAPSE), peak systolic velocity at lateral tricuspid annulus, isovolumic acceleration and fractional area change (FAC). Global RV systolic strain as well as, segmental strain at basal, mid and apical septum showed a statistically significant rise after BMV. TAPSE and FAC also increased significantly post BMV.
  
  
  CONCLUSIONS
  RV systolic function is impaired in patients with severe MS and can be assessed by global and segmental RV strain before the appearance of clinical signs of systemic venous congestion. Impaired global and segmental RV strain values in these patients are primarily due to increased after load and improve after BMV with reduction in RV afterload.
authors.affiliation: Assistant Professor, Department of Cardiology, Christian Medical College & Hospital, Vellore, India. Electronic address: docvipin2005@gmail.com.
authors.forename: Vipin
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Professor, Department of Cardiology, Christian Medical College & Hospital, Vellore, India.
authors.forename: V Jacob
authors.initials: VJ
authors.lastname: Jose
authors.affiliation: Professor, Department of Cardiology, Christian Medical College & Hospital, Vellore, India.
authors.forename: Purendra Kumar
authors.initials: PK
authors.lastname: Pati
authors.affiliation: Associate Professor, Department of Cardiology, Christian Medical College & Hospital, Vellore, India.
authors.forename: John
authors.initials: J
authors.lastname: Jose
mesh_terms: D000328:Adult; D063126:Balloon Valvuloplasty / Q000379:methods*; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D015588:Observer Variation; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000502:physiology
keywords: Balloon mitral valvuloplasty; Mitral stenosis; Right ventricular function; Strain; Strain rate