The Correlation Between Mitral Valve Area (MVA) Assessed Using Planimetry, Mean Trans-Mitral Gradient (MV mean PG) and Pulmonary Artery Systolic Pressure (PASP) on Global Longitudinal Strain (GLS) of The Left Ventricle in Rheumatic Mitral Stenosis

Background: Rheumatic heart disease (RHD) remains a global health issue, especially in developing countries, with mitral stenosis being one of the most common manifestations.  Assessment of left ventricular function in patients with mitral stenosis due to rheumatic heart disease is generally performed using conventional echocardiography; however, this method has limitations in detecting subclinical left ventricular dysfunction.  Global Longitudinal Strain (GLS) through speckle tracking echocardiography (STE) has been introduced as a more sensitive method in detecting left ventricular contractility disorders.  This study aims to examine the relationship between echocardiographic parameters, including MVA calculated with planimetry, MV Mean PG, and PASP, with the left ventricular GLS values in patients suffering from mitral stenosis due to rheumatic heart disease (RHD).

Method: This cross-sectional observational study involved 72 patients diagnosed with mitral stenosis due to rheumatic heart disease treated at RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar.  Echocardiographic examination was conducted to assess MVA, MV Mean PG, and PASP in relation with GLS values which is measured using STE.

Results: A total of 74 samples were involved in this analysis.  A significant correlation was found between GLS and MV Mean PG (r = -0.238, p = 0.013), where the higher the mean transmitral gradient, the lower the GLS value.  A positive correlation was also found between MVA planimetry and GLS (r = 0.329, p = 0.004), indicating that the larger the mitral valve area, the better the left ventricular function, but statistically non-significant.  Additionally, PASP shows a negative correlation with GLS (r = -0.17, p = 0.031), which means that the higher the pulmonary artery systolic pressure, the lower the GLS value of the left ventricle.

Conclusion: GLS is a reliable predictor of left ventricular dysfunction in patients with rheumatic mitral stenosis, with PASP and MV Mean PG as significantly influential factors.  On the other hand, MVA by Planimetry has been shown a non-significant correlation to LV GLS.