Early detection of cardiac function by tissue Doppler imaging in patients with mitral stenosis and sinus rhythm

Objectives: We evaluated the changes in left ventricular function by means of tissue Doppler imaging (TDI) in patients with mitral stenosis (MS). Study design: Standard echocardiographic and TDI studies were performed in 26 patients (18 females, mean age 38 +/- 7 years) with severe MS [mitral valve area (MVA) <1.2 cm(2)], in 32 patients (24 females, mean age 35 +/- 9 years) with mild to moderate MS (MVA >= 1.2 cm(2)), and in 25 agematched healthy volunteers (17 females, mean age 39 +/- 6 years). All the patients were in sinus rhythm and none had hypertension or coronary artery disease. Systolic myocardial velocity, early and late diastolic velocities were measured in the basal lateral segment and basal interventricular septum from the apical four-chamber views. Results: Left ventricular dimensions, ejection fraction, end-diastolic and end-systolic diameters, and fractional shortening of the left ventricle were similar in all the groups. Patients with MS had significantly decreased peak systolic myocardial velocities in both the lateral wall and interventricular septum of the left ventricle. In addition, early diastolic velocity and the ratio of early/late diastolic velocities were significantly lower. E-wave deceleration time and late diastolic myocardial velocities were similar in three groups. Peak systolic myocardial velocities were significantly correlated with mitral valve areas measured at the septum (r=0.57, p<0.01) and the lateral wall (r=0.48, p<0.01) of the left ventricle. Conclusion: Our results show that, despite the presence of seemingly normal findings on standard echocardiography, TDI may provide evidence for left ventricular systolic dysfunction in patients with MS, representing early signs of myocardial abnormality.