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Relationship between New York functional class and duke activity status index with the severity of mitral valve
Leila Bigdelu1, Hedieh Alimi1, Hoorak Poorzand1
1Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
Severe mitral stenosis (MS) symptoms correlate with echocardiographic measures. Left atrial strain (LASr) showed the strongest association with patient functional capacity and disease severity in this study.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Physiology
Background:
- Severe mitral stenosis (MS) significantly impacts cardiac function and patient symptoms.
- Accurate assessment of MS severity and its correlation with functional status is crucial for management.
- Echocardiographic parameters, including novel strain analysis, may offer insights into MS-related functional limitations.
Purpose of the Study:
- To investigate the relationship between symptoms in severe rheumatic MS patients, assessed by NYHA functional class and DASI score, and echocardiographic parameters.
- To evaluate the association of left atrial reservoir auto-strain (LASr) with functional capacity and disease severity in MS.
- To determine the correlation between various echocardiographic findings and patient-reported functional status.
Main Methods:
- Evaluated 60 patients with severe rheumatic MS (MVA < 1.5 cm²).
- Performed transthoracic echocardiography, including left atrium reservoir auto-strain (LASr) analysis.
- Assessed patient symptoms and functional capacity using New York Heart Association (NYHA) functional class and Duke Activity Status Index (DASI) scores.
Main Results:
- NYHA class correlated positively with LA area, volume, volume index, E, A, and PAP, and negatively with LASr and MVA.
- DASI score associated positively with LASr and MVA, and negatively with LA dimensions, E, A, and PAP.
- LASr demonstrated the strongest correlation among all measured echocardiographic parameters with patient functional status in severe MS.
Conclusions:
- Echocardiographic parameters including LA dimensions, filling pressures, MVA, and LASr are significantly associated with NYHA and DASI scores in severe MS patients.
- LASr is a robust indicator of functional capacity and disease severity in severe MS.
- These findings highlight the utility of advanced echocardiographic techniques like LASr in assessing the clinical impact of MS.
Abstract:
Purpose This study aimed to investigate the relationship between symptoms of patients with severe mitral stenosis (MS), evaluated by the New York Heart Association (NYHA) functional class and Duke Activity Status Index (DASI) score, and echocardiographic parameters. We evaluated patients with severe rheumatic MS diagnosed as mitral valve area (MVA) less than 1.5 cm2. All patients underwent transthoracic echocardiography and the left atrium (LA) reservoir auto-strain (LASr) analysis. In addition, DASI and NYHA scores were determined to evaluate the functional capacity and symptoms of MS patients. We evaluated 60 patients with MS with a mean age of 50.13 ± 10.28 and a median DASI score of 26.95 (26.38). There were 6 (10%) and 28 (46.7%) patients with NYHA class I and II, and 25 (40.0%) and 2 (3.3%) patients with NYHA class III and IV, respectively. NYHA class was positively correlated with LA area (LAA, r = 0.638), LA volume (LAV, r = 0.652), LAV index (LAVI, r = 0.62), E (r = 0.45), A (r = 0.25), and pulmonary artery pressure (PAP, r = 0.34), while negatively correlated with LASr (r = - 0.73) and MVA (r = - 0.417). Furthermore, the DASI score was positively associated with LASr (r = 0.81) and MVA (r = 0.52) while negatively correlated with LAA (r = - 0.62), LAV (r = - 0.65), LAVI (r = - 0.56), E (r = - 0.46), A (r = - 0.3), and PAP (r = - 0.32). Our findings indicate that LAA, LAV, LAVI, E, A, PAP, MVA, and LASr are associated with NYHA and DASI scores in MS patients. Additionally, the LASr had the strongest correlation between all measured parameters in severe MS patients.
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