Akademik Veri Yönetim Sistemi
1. Avrasya Kalp Yetersizliği Kongresi , Muğla, Türkiye, 10 - 13 Ekim 2024, ss.86-88, (Tam Metin Bildiri)
Background: Rheumatic mitral stenosis continues to be a significant public health issue in developing countries. Advances in the field of echocardiography have made it possible to noninvasively assess the physiomechanics of the atria. In our study, we aim to evaluate the changes in left atrial phasic functions in patients with mitral stenosis, a condition that directly affects the left atrium, and to investigate the relationship between these changes and clinical signs and symptoms. In our study, we also investigated the six-minute walk distance, an objective clinical measure of functional capacity, and predictors of intervention decisions. Methods: Patients with rheumatic mitral stenosis who do not have comorbidities affecting cardiac functions were included. In addition to conventional echocardiographic parameters, biventricular deformation analyses were evaluated using 2D-speckle tracking echocardiography (STE). Biatrial phasic functions were assessed using both 2D and 3D-STE and were compared with clinical signs and symptoms. Results: The study population consisted of 30 healthy subjects, 31 patients with moderate rheumatic mitral stenosis in sinus rhythm, 31 patients with severe rheumatic mitral stenosis in sinus rhythm, and 30 patients with severe mitral stenosis in persistent atrial fibrillation. In the patient group with severe mitral stenosis in sinus rhythm, the contractile left atrial strain values were significantly higher. Left atrial peak longitudinal (reservoir) strain values were found to be significantly lower in patients with severe mitral stenosis by being lowest lowest in the group with atrial fibrillation. In groups with more severe mitral stenosis, right atrial phasic strain values were found to be significantly lower in both 2D and 3D measurements by also being lowest in the group with atrial fibrillation. Echocardiographic parameters found to predict the six-minute walk distance were LV-GLS, sePAP, and LA reservoir LS. The best predictors of intervention decisions were found to be sePAP and RV-FWLS. Conclusion: Mitral stenosis and atrial fibrillation affect the physiomechanics of the left and right atrium. In mitral stenosis, the increased left atrial afterload in patients with sinus rhythm is compensated by an increase in contractile function. However, this compensatory increase is insufficient to preserve left atrial reservoir function. Patients with mitral stenosis who develop atrial fibrillation lack the compensatory contractile function, and this deficiency underlies the increased clinical deterioration associated with the development of atrial fibrillation. Keywords: atrial phasic deformation, mitral stenosis, speckle tracking echocardiography, valvular heart disease