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\begin{document}

\title{Evaluation of Left Atrial and Ventricular Function at Rest and
Post-exercise by Speckle Tracking in Patients with Mild Mitral Stenosis}



\author[1]{irem Muge Akbulut}%
\author[2]{Cansin Tulunay Kaya}%
\author[3]{Demet Gerede}%
\affil[1]{Ankara University Faculty of Medicine}%
\affil[2]{Ankara University School of Medicine}%
\affil[3]{Ankara University}%


\vspace{-1em}



  
  \date{May 08, 2024}


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\selectlanguage{english}
\begin{abstract}
Rheumatic mitral stenosis is a leading cause of morbidity in developing
countries. Symptomatic patients with mitral valve area\textgreater{}1.5
cm2 comprises a gray zone in management. Exercise stress testing is
recommended in these patients with symptoms discordant with the severity
of the stenosis. Left atrial strain analysis with speckle tracking
imaging emerges as a promising technique for the evaluation of
haemodynamics better. The aim of our study is to examine the left atrial
and ventricular function both during rest and just after exercise by
speckle tracking imaging in patients with mild rheumatic mitral stenosis
and ascertain early hemodynamic deterioration. We included 46 patients
with mild mitral stenosis (mitral valve area\textgreater{}1.5 cm2) The
patients were evaluated with comprehensive 2D and Doppler
echocardiography during rest, before the exercise stress test. Left
atrial and ventricular peak systolic strain values were calculated by
using a software program. Exercise stress test was then performed by
using treadmill with standard Bruce protocol. Immediately after the
termination of the test, the echocardiographic examination was repeated.
Both mean trans-mitral gradient and systolic pulmonary artery pressure
values were higher following exercise (p\textless{}0.001, p=0.001,
respectively). Exercise did not cause a significant chance in left
atrial and ventricular peak systolic strain value (p=0.708, p=0.854). A
negative significant correlation was found between the mean trans-mitral
gradient and peak systolic left atrial strain following exercise. In
patients with mitral valve area\textgreater{}1.5 cm2, exercise stress
test did not cause a significant change in left atrial and ventricular
peak systolic strain.%
\end{abstract}%



\sloppy


\textbf{Evaluation of Left Atrial and Ventricular Function at Rest and
Post-exercise by Speckle Tracking in Patients with Mild Mitral Stenosis}

\textbf{ABSTRACT}

\textbf{Introduction}

Rheumatic mitral stenosis is a leading cause of morbidity in developing
countries. It has adverse hemodynamic effects on both pulmonary
circulation and left atrium that may not be completely determined by
conventional transthoracic echocardiographic techniques. Symptomatic
patients with mitral valve area\textgreater{}1.5
cm\textsuperscript{2}comprises a gray zone in management. Therefore,
exercise stress testing is recommended in these patients with symptoms
discordant with the severity of the stenosis. Left atrial strain
analysis with speckle tracking imaging emerges as a promising technique
for the evaluation of these hemodynamic effects better. Despite the
well-known fact that the left ventricle is spared from the deleterious
hemodynamic effects of mitral stenosis, some new research has recently
revealed that it might actually be associated with sub-clinical left
ventricle dysfunction. The aim of our study is to examine the left
atrial and ventricular function both during rest and just after exercise
by speckle tracking imaging in patients with mild rheumatic mitral
stenosis and ascertain early hemodynamic deterioration.

\textbf{Methods}

We included 46 patients with mild mitral stenosis (mitral valve
area\textgreater{}1.5 cm\textsuperscript{2}) between January
2015-January 2016. The patients were evaluated with comprehensive 2D and
Doppler echocardiography during rest, before the exercise stress test.
Left atrial and ventricular peak systolic strain values were calculated
by using a software program (Figure 1\&2). Exercise stress test was then
performed by using treadmill with standard Bruce protocol. All of the
patients completed the test successfully and reached the 85\% of age
predicted maximal heart rate. Immediately after the termination of the
test, the echocardiographic examination was repeated.

\textbf{Results}

Both mean trans-mitral gradient and systolic pulmonary artery pressure
values were found to be significantly higher following exercise
(p\textless{}0.001, p=0.001, respectively). Exercise did not cause a
significant chance in left atrial and ventricular peak systolic strain
value (p=0.708, p=0.854) (Table 1). A negative significant correlation
was found between the mean trans-mitral gradient and peak systolic left
atrial strain following exercise (p=0.039, r=-0.361).

\textbf{Conclusion}

In patients with mitral valve area\textgreater{}1.5
cm\textsuperscript{2}, exercise stress test did not cause a significant
change in left atrial and ventricular peak systolic strain.

\textbf{Hosted file}

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\textbf{Hosted file}

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