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Left ventricular diastolic function in mitral stenosis
  • Ashwin Venkateshvaran,
  • Satish Govind
Ashwin Venkateshvaran
Karolinska Institute
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Satish Govind
Narayana Institute of Cardiac Sciences
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Peer review status:ACCEPTED

20 Apr 2020Submitted to Echocardiography
21 Apr 2020Submission Checks Completed
21 Apr 2020Assigned to Editor
21 Apr 2020Reviewer(s) Assigned
21 May 2020Review(s) Completed, Editorial Evaluation Pending
21 May 2020Editorial Decision: Revise Minor
31 May 20201st Revision Received
01 Jun 2020Submission Checks Completed
01 Jun 2020Assigned to Editor
01 Jun 2020Reviewer(s) Assigned
01 Jun 2020Review(s) Completed, Editorial Evaluation Pending
01 Jun 2020Editorial Decision: Accept

Abstract

The assessment of left ventricular (LV) function in the setting of mitral stenosis (MS) has been critically examined for decades. Accurate assessment of aberrations in diastolic function is important as these subjects often present with signs and symptoms of heart failure and pulmonary congestion that cannot be solely explained by the severity of mechanical obstruction. Echocardiographic evaluation of diastolic dysfunction includes an evaluation of reduced LV compliance, diminished restoring forces and enhanced stiffness, which are challenging in the setting of MS owing to altered hemodynamic loading. Conventional echocardiographic and Doppler measures offer limited information. Novel assessments employing speckle tracking echocardiography are relatively less studied. A more comprehensive assessment including clinical evaluation, identification of concomitant disorders and comorbidities is particularly warranted in older subjects with degenerative MS to suspect diastolic dysfunction and arrive at optimal medical therapy or intervention. This review provides an overview of etiological, pathophysiological, echocardiographic and invasive assessment of diastolic dysfunction in the setting of MS, with specific focus on strengths and limitations of available echocardiographic and Doppler techniques.