Assessment of Left Ventricular Global Longitudinal Strain in Rheumatic Mitral Stenosis Using Speckle-Tracking Echocardiography

Abstract

Objective: This study aimed to evaluate left ventricular systolic function using speckle-tracking echocardiography (STE)–derived global longitudinal strain (GLS) in patients with rheumatic mitral stenosis and to examine its relationship with the severity of mitral valve obstruction and associated hemodynamic changes. Methodology: This case–control study included 80 participants, comprising 60 patients with rheumatic MS in sinus rhythm and 20 healthy controls. Patients were stratified according to mitral valve area (MVA) into mild (>1.5 cm²), moderate (1.0–1.5 cm²), and severe (<1.0 cm²) MS groups. Conventional echocardiographic measurements were obtained, and GLS was assessed using two-dimensional speckle-tracking echocardiography from apical two-, three-, and four-chamber views. Results: Among the 80 participants, patients with MS were significantly older (41.30±8.64 vs 31.05±5.63 years; P<0.001) and had a higher proportion of females (73.3% vs 45.0%; P=0.02) compared with controls. LVEF was preserved and comparable between groups (63.18±3.95% vs 64.10±4.06%). However, patients with MS exhibited significantly higher right ventricular systolic pressure (RVSP), larger left atrial diameter, and lower absolute GLS (|GLS|). Mitral valve area showed a positive correlation with |GLS| (r=0.498; P<0.001) and negative correlations with RVSP (r = −0.634; P<0.001) and left atrial diameter (r = −0.748; P<0.001). Conclusion: Speckle-tracking echocardiography–derived GLS detects alterations in left ventricular longitudinal mechanics in patients with rheumatic mitral stenosis despite preserved LVEF, with the greatest impairment observed in severe disease.