Evaluation of left ventricular long-axis function in cases of rheumatic pure mitral stenosis with atrial fibrillation

Using tissue Doppler echocardiography, we evaluated left ventricular long-axis function in 65 mitral stenosis patients, 30 of whom were in sinus rhythm and 35 of whom were in chronic atrial fibrillation. There were 35 healthy control subjects. Conventional echocardiography was used to evaluate left ventricular diameters, left atrial diameters, left ventricular ejection fractions, and mitral valve areas. Tissue Doppler echocardiography was used to evaluate isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), ejection time (ET), and peak systolic myocardial velocities. The myocardial performance index was calculated with the formula (ICT+IRT)/ET. Mean and segmental left ventricular IRT and ICT values were significantly longer in mitral stenosis patients than in control subjects, but were similar in the sinus rhythm and atrial fibrillation subgroups. Ejection times were significantly lower in the mitral stenosis with atrial fibrillation group than in the mitral stenosis with sinus rhythm and control groups (P<0.001), but were similar when the sinus rhythm group was compared with the control group (P<0.05). Myocardial performance index values were higher in mitral stenosis patients, significantly so in those with atrial fibrillation when compared with the control group (P<0.001). Systolic velocity values were significantly lower in mitral stenosis patients, more markedly so in those with atrial fibrillation than in the control group (P<0.001). We conclude that patients with pure rheumatic mitral stenosis, most particularly when in combination with atrial fibrillation, have significantly impaired left ventricular long-axis function as evaluated by tissue Doppler echocardiography, although global systolic function may be normal.