Does Tight Mitral Stenosis Protect the Left Ventricle?: Strain vs Simpson Biplan: An Echographic Study of 50 Cases

Introduction: Mitral stenosis is one of the most frequent valve diseases in Morocco. Mitral stenosis had been considered for several years as a protective left ventricular valve disease. However, many studies have disapproved of this theory. The advent of different imaging techniques has made it possible to make a drastic contribution to these different studies. Through our work we have tried to confirm this theory while reviewing the literature on this subject.

Materials and Methods: This retrospective study included 50 patients who had been admitted for symptomatic mitral stenosis in Mohamed V Military Teaching Hospital in Rabat, Morocco, from January 2015 to June 2021. MORE than 100 patients have been reviewed but only 50 cases were exploitable concerning the longitudinal strain. Patients with ischemic heart disease or associated hypertensive heart disease or other valvular disease were excluded. All of the patients had a clinical examination, EKG, transthoracic echocardiography. Only the Patients who had a severe and symptomatic mitral stenosis with no other significant valve disease were include in this study.

Results: During our study, we analyzed 50 echocardiograms of patients with severe mitral stenosis, 15 men (30%) and 35 women (70%). we had an average 2D global Strain of -15%+/- 4 in women and - 15%+/-3 in men. An average LVEF value of 55% +/- 7 in women and 54% +/- 8 in men, in our study we found that 28 patients had concordant results between the Strain2D and the LVEF retained by Simpson biplane. on the other hand, out of the 50 patients included in the study, 22 patients or 44% had an altered Strain while they presented a normal LVEF (> 50%).

Conclusion: Mitral stenosis has been considered for years as LV protective valvular disease. But the advent of new imaging techniques has proven otherwise. Several etiologies of this LV dysfunction have been studied but the conclusion is the same: it is necessary to multiply the imaging modalities, in particular the 2D STRAIN, to have a better study of the LV function and the achievement of the different walls during a tight mitral stenosis.