Right ventricular systolic function in patients with rheumatic mitral Stenosis

Background: Right ventricule(RV) function affects the outcome in valvular heart disease but it less assessed in mitral stenosis. Our study aims to define the incidence of RV dysfunction in patients with moderate to severe rheumatic mitral stenosis using simple parameters and to correlate it with other echocardiographic parameters. Methods: 75 patients with moderate to severe rheumatic mitral stenosis and 24 controls underwent echocardiographic examinations. RV function indices included Tricuspid annular plane excursion (TAPSE), peak S’ velocity at tissue Doppler (S’) and RV fractional area shortening (FAS). Results: compared to controls, patients with MS had significantly lower TAPSE (17±5 vs 20mm, p<0.001), lower FSA (0.43±0.1 vs 0.52±0.2%, p=0.03) and lower S’ (11±3 vs 13±1 cm/s, p=0.002). Right ventricular dysfunction was noted in 38% (by TAPSE), in 37% (by S’) and in 35% (by FSA). A good correlation was noted between these three parameters. RV systolic dysfunction was significantly more frequent in patients with atrial fibrillation (AF) than those in sinus rhythm (60% vs 20%, p<0.001), and left atrial area was significantly higher in patients with right ventricular dysfunction (34.8 cm² vs 31.6 cm², p=0.04). A cut-off value of 34cm² can predict right ventricular dysfunction with 86% sensitivity and 77% specificity. No correlation was found between the three parameters of RV function and systolic pulmonary artery pressure. Conclusion: systolic RV function, assessed by simple echocardiographic parameters, was reduced in 35% of patients with moderate to severe mitral stenosis. RV dysfunction was more frequent in patients with AF and with more dilated left atrium