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. 2021 Jun 4:8:674435.
doi: 10.3389/fcvm.2021.674435. eCollection 2021.

Left Ventricular Remodeling Following Balloon Mitral Valvuloplasty in Rheumatic Mitral Stenosis: Magnetic Resonance Imaging Study

Amir Anwar Samaan  1   2 , Karim Said  1   2 , Wafaa El Aroussy  1 , Mohammed Hassan  1 , Soha Romeih  2 , Amr El Sawy  2 , Mohammed Eid Fawzy  1 , Magdi Yacoub  2   3
Affiliations

Left Ventricular Remodeling Following Balloon Mitral Valvuloplasty in Rheumatic Mitral Stenosis: Magnetic Resonance Imaging Study

Amir Anwar Samaan et al. Front Cardiovasc Med. .

Abstract

Background: Rheumatic heart disease affects primarily cardiac valves, it could involve the myocardium either primarily or secondary to heart valve affection. The influence of balloon mitral valvuloplasty (BMV) on left ventricular function has not been sufficiently studied. Aim: To determine the influence of balloon mitral valvuloplasty (BMV) on both global and regional left ventricular (LV) function. Methods: Thirty patients with isolated rheumatic mitral stenosis (MS) were studied. All patients had cardiac magnetic resonance imaging (CMR) before, 6 months and 1 year after successful BMV. LV volumes, ejection fraction (EF), regional and global LV deformation, and LV late gadolinium enhancement were evaluated. Results: At baseline, patients had median EF of 57 (range: 45-69) %, LVEDVI of 74 (44-111) ml/m2 and LVESVI of 31 (14-57) ml/m2 with absence of late gadolinium enhancement in all myocardial segments. Six months following BMV, there was a significant increase in LV peak systolic global longitudinal strain (GLS) (-16.4 vs. -13.8, p < 0.001) and global circumferential strain (GCS) (-17.8 vs. -15.6, p = 0.002). At 1 year, there was a trend towards decrease in LVESVI (29 ml/m2, p = 0.079) with a significant increase in LV EF (62%, p < 0.001). A further significant increase, compared to 6 months follow up studies, was noticed in GLS (-17.9 vs. -16.4, p = 0.008) and GCS (-19.4 vs. -17.8 p = 0.03). Conclusions: Successful BMV is associated with improvement in global and regional LV systolic strain which continues for up to 1 year after the procedure.

Keywords: balloon mitral valvuloplasty; cardiac magnetic resonance imaging; left ventricular deformation; left ventricular function; left ventricular remodeling; mitral stenosis; myocardial tagging.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CMR Measurements of ventricular volumes in one of mitral stenosis patients. End diastolic short-axis images from the apex to the base with epicardial (green lines) and endocardial (red lines) contours drawn for the left ventricle and endocardial contours for the right ventricle.
Figure 2
Figure 2
Tagged cardiac magnetic resonance imaging with epicardial and endocardial border tracing in: short axis (A), horizontal long axis (apical four chambers) (B), vertical long axis (apical two chambers) (C), and left ventricular outflow view (three chambers views) (D). The short axis images were used for estimation of circumferential strain while long axis views were used for estimation of longitudinal strain.
Figure 3
Figure 3
(A) Measurement of regional and global circumferential strain (Bull's eye plot) in a patient with mitral stenosis before and 1 year after BMV with comparison to a control individual (B) Graph representation of GCS in a patient with mitral stenosis before and after BMV in comparison to a control individual.
Figure 4
Figure 4
Bar graphs showing Changes in LV GLS after BMV (A) and Changes in LV GCS after BMV (B).
Figure 5
Figure 5
Line chart representing changes in GLS and GCS in individual mitral stenosis patients 1 year after BMV.
Figure 6
Figure 6
Correlation between change in LV deformation parameters and baseline values. (A) Correlation between change in GLS and baseline GLS. (B) Correlation between change in GCS and baseline GCS.
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