Right Ventricular diastolic function assessment by tissue Doppler in Mitral Stenosis-Correlation with functional capacity.

INTRODUCTION : Rheumatic heart disease still remains a major cause of morbidity and mortality in developing nations with recent reports suggesting approximately 15 million cases in these countries. The above figure may underestimate the actual burden of this disease as these estimates are based on prevalence data obtained by comprehensive clinical screening rather than echocardiographic screening which might detect approximately 10 times as many cases in South East Asia and Sub-saharan Africa. Mitral Stenosis (MS) due to rheumatic heart disease is associated with considerable fusion of commissures and reduction of mitral valve apparatus and leaflet mobility. Although symptoms of dyspnoea and fatigue are common in patients with mitral stenosis, mechanisms that limit exercise tolerance are poorly understood. It is well known that determination of functional capacity in cardiovascular disease is very essential for the evaluation of response to treatment, prognosis and timing of invasive procedures . In isolated mitral stenosis invasive procedures are recommended for symptomatic patients with valvular area of less than or equal to 1.5cm2 according to ACC/AHA guidelines . Intervention in mitral stenosis is generally indicated when symptoms occur or when pulmonary hypertension develops. Therefore, whether patient is symptomatic or not is important. Increasing mitral valve obstruction leads to progressive elevation in capillary and pulmonary artery pressure (PAP) and augmented symptoms. Therefore, identification of the determinants of PAP in mitral stenosis is clinically important. Risk of right ventricular dysfunction always exists due to reactive vascular changes in pulmonary arteries and rheumatic myocardial involvement in mitral stenosis. At times termed "the forgotten ventricle", the right ventricle plays an important role in clinical presentation in mitral stenosis and many such cardiac pathologies. The right ventricular systolic function is an important determinant of clinical symptoms, exercise capacity, pre operative survival and post operative outcomes in patients with mitral stenosis. There has been lot of studies which showed the importance of right ventricular systolic function in mitral stenosis, but very limited data cocncentrating on diastolic function . In the present study we tried to assess right ventricular diastolic function and Tei Index and compared them between asymptomatic and symptomatic patients with moderate to severe mitral stenosis. AIMS AND OBJECTIVES : 1. To assess the incidence of right ventricular diastolic dysfunction in asymptomatic and symptomatic patients with moderate to severe rheumatic mitral stenosis. 2. To assess the relation between symptomatic and asymptomatic rheumatic mitral stenosis patients and right ventricular Tei index as calculated by colour tissue Doppler. CONCLUSION : 1. 93% (28 out of 30) of symptomatic and 29% (6 out of 21) of asymptomatic patients had right ventricular diastolic dysfunction in presence of moderate to severe rheumatic mitral stenosis. 2. Right ventricular Tei index did not show any correlation with symptom class in moderate to severe rheumatic mitral stenosis patients