Assessment Of Left Atrial Function In Patients Pre-and Post-mitral Valvuloplasty By Using Two-dimensional Speckle Tracking Echocardiography

ObjectivesThe aim of this study is to evaluate the change of left atrial function after mitral valvuloplasty in patients with mitral valve prolapse by measuring left atrial strain using two-dimensional speckle tracking echocardiography (2D-STE) and the clinical application value of the strain imaging.Materials And MethodsStudy population consisted of25healthy subjects and25patients with mitral valve prolapse during the period from March to July of2012. Left atrial diameter (LAD), left ventricular end-diastolic diameter (LVDD), left ventricular ejection fraction(LV-EF), regurgitant jet area/left atrium area(RJA/LAA) were measured using a Philips IE33ultralsound scanner. High frame rate two-dimensional images were recorded in the apical four chamber view and two chamber view. Images of patients with mitral valve prolapse were respectively recorded at pre-operation,3days and3months post-operation. Left atrial longitudinal strain was measured in two views using two-dimensional strain soft ware, including peak atrial longitudinal strain (PALS), time-to-peak of peak atrial longitudinal strain (TPLS), peak atrial contraction strain (PACS) and atrial longitudinal strain during early diastole (ALSE). In addition, maximal left atrial volume (LA Vmax), pre-atrial contraction left atrial volume (LA VpreA), minimal left atrial volume (LA Vmin), left atrial passive empting fraction (LAPEF) and left atrial active empting fraction (LAAEF) were obtained from time-left atrial volume curve. Measurement data was analyzed by analysis of variance. Pearson correlation analysis was used to examine the correlation between two variables. P<0.05was considered statistically significant.Results1. Compared with the control group, LAPEF, LAAEF, global PALS, PACS and ALSE decreased in patients with mitral valve prolapse, but LAD, LVDD, Vmax, Vmin, VpreA and global TPLS increased. RJA/LAA in patients with mitral valve prolapse correlated negatively with global PALS(r=-0.620, P<0.01).2. Compared with preoperative group, global PALS, PACS, ALSE, TPLS and LVDD decreased significantly3days after surgery. LAD, Vmax, Vmin, VpreA, LAPEF and LAAEF did not differ significantly.3. Compared with preoperative group, LAPEF, LAAEF, global PALS, ALSE and PACS increased3months after surgery. In addition, LAD, LVDD, Vmax, Vmin and VpreA decreased, but global TPLS did not differ significantly.ConclusionIn patients with chronic mitral regurgitation, the pump function, conduit function and reservoir function of left atrium were impaired and decreased gradually. The conduit function, the reservoir function and the pump function recovered3months after mitral valvuloplasty. However, TPLS did not normalize after mitral valvuloplasty, indicating persistent atrial dysfunction despite in spite of surgery.It indicates that2D-STE could accurately evaluate the change of left atrial function and provide more detailed information about left atrial mechanics after mitral valvuloplasty.