Evaluation The Alteration Of Left Ventricular Long-axis Function In Patients With Rheumatic Mitral Stenosis Using Tissue Doppler Imaging

Objective To detect the alteration of left ventricular long-axis systolic and diastolic function in patients with rheumatic mitral stenosis (MS) and investigate its clinical significance. Methods Using tissue Doppler imaging, the mitral annular systolic peak velocity (S_m), the systolic excursion (D_S), the pre-contraction time (PCT_m), contraction time (CT_M) and PCT_m/CT_m ratio ,early diastolic peak velocity (E_M),late diastolic peak velocity (A_M) and E_M / A_M ratio were measured in 67 patients with isolated MS and 50 healthy volunteers. In addition, the pre-and postoperative (three and six month) left ventricular long-axis function were measured by tissue Doppler imaging in 24 patients with mitral valve replacement(MVR). Results According left ventricular ejection fraction (EF), 67 patients with MS were further divided into two subgroups, i.e. nonnal EF containing 58 patients with EF of more than 50% and decreased EF group containing 9 patients with EF of less than 50%. S_M in patients with either of normal EF and decreased EF was significantly lower than in controls (P<0.01), and in patients with decreased EF was lower than in patients with normal EF (P<0.01). D_S in patients with either of normal EF and decreased EF was significantly lower than in controls (P<0.01, P<0.001), and in patients with decreased EF was lower than in patients with normal EF (P<0.01). PCT_m/CT_m ratio in patients with either of normal EF and decreased EF was bigger than in controls (P<0.05, P<0.01), and in patients with decreased EF was bigger than in patients with normal EF (P<0.05). The incidences of long-axis systolic dysfunction in MS patients with normal EF and those with decreased EF were respectively 60.2% and 100%. E_m in patients with either of normal EF and decreased EF was significantly lower than in controls (P<0.001), and in patients with decreased EF was lower than in patients with normal EF (P<0.001). A_M in patients with either of normal EF and decreased EF was significantly lower than in controls (P<0.01, P<0.001), and in patients with decreased EF was lower than in patients with normal EF (P<0.01). E_M / A_M ratio in patients with either of nonnal EF and decreased EF was lower than in controls (P<0.05, P<0.01), and in patients with decreased EF was lower than in patients with nonnal EF (P<0.01). S_m, D_s , PCT_m/CT_m ratio and A_M correlated with mitral effective orifice area in patients with MS (r=0.48, P<0.01; r=0.35, P<0.01; r=-0.26, P<0.05, r=0.46, P<0.05 respectively). S_M and D_S correlated with mitral effective orifice MPG in patients with MS (r=-0.47, P<0.05; r=-0.43, P<0.05; respectively). 24 patients with MVR S_M and D_S with either of post-operative 3 month and 6 month was bigger than pre-operative (P<0.01) ,and post-operative 6 month was bigger than post-operative 3 month (P<0.05). PCT_m/CT_m ratio with either of post-operative 3 month and 6 month was decreased than pre-operative (P<0.05, P<0.01). E_M with either of post-operative 3 month and 6 month was significantly bigger than pre-operative (P<0.001), and post-operative 6 month was bigger than post-operative 3 month (P<0.01). A_M with either of post-operative 3 month and 6 month was bigger than pre-operative (P<0.01). E_M /A_M ratio with either of post-operative 3 month and 6 month was bigger than pre-operative (P<0.05, P<0.01). Conclusions Left ventricular long-axis systolic and diastolic dysfunction exists in the majority of patients with MS, and it occurs before left ventricular short-axis dysfunction. Left ventricular long-axis systolic and diastolic function was significantly increased in patients with mitral stenosis...