Objectives: Comparing effects of mitral stenosis and mitral regurgitation on LA deformation using twodimensional speckle tracking echocardiography.
Methods: Fifty patients with isolated moderate to severe MS, fifty patients with isolated moderate to severe MR and normal left ventricular ejection fraction (EF≥ 55%) were compared using one way analysis of variance (ANOVA) test with two-group comparisons. LA reservoir strain was calculated as peak systolic atrial longitudinal strain, LA reservoir strain rate as peak systolic positive value, LA conduit SR as the early diastolic negative peak, and LA contractile SR as the late diastolic negative peak with QRS onset as the reference point.
Results: There was a statistically significant difference between the LA average PALS (p<0.001), SRS (p=0.012), SRE (p<0.001), TTP strain (p<0.001), SRA (p=0.010), and TTP SRE (p=0.005) of the 2 patient groups. LA average PALS was significantly higher in MR compared to MS patients (p<0.001).The average SRS, SRE and SRA were nearly similar in MS and MR patients. The TTP strain and TTP SRE were significantly shorter in MR compared to MS patients (p<0.001and p= 0.005, respectively). Significant inverse correlations were noted between the LA volume index (LAVI) and average PALS (r=-0.898, P<0.001), SRS (r=-0.927, P<0.001), SRE (r=-0.938, P<0.001) and SRA (r=-0.957, P<0.001) in MR patients.
Conclusion: Left atrial PALS, TTP strain, and TTP SRE can differentiate between volume overloaded and pressure overloaded left atrium. Pressure overload seems to have a more pronounced effect on LA mechanics.
Keywords: Speckle tracking, mitral stenosis, mitral regurgitation, strain, strain rate, left atrium