Use of strain and strain rate echocardiographic imaging to predict the progression of mitral stenosis: a 5-year follow-up study

Despite the decreasing frequency of mitral stenosis (MS) in developed countries, it is still common, especially in developing countries (1). Although there have been improvements in its diagnosis and management, MS is still leading to morbidity. After MS develops, the mean decrease of the valve area is nearly 0.1 cm2 per year (2). Recently, there have been some clinical studies on the incidence and progression of MS and rheumatic heart disease (3, 4). However, there are no adequate data available on which patients will see more rapid progressions. A few laboratory studies have investigated the indicators of MS progression (5, 6), and little data exist involving echocardiographic parameters leading to the deterioration of MS. It is known that left ventricular (LV) systolic functions are generally well preserved in patients with MS (1, 7). However, some studies have shown impaired LV systolic functions in patients with pure MS (8–10). Rheumatic myocarditis, known as a myocardial factor, could be the mechanism responsible for LV dysfunction, and we also speculate that it may cause the progression of MS. However, there are no studies published investigating the relationship between the progression of MS and the LV strain which shows subclinical LV systolic dysfunction. In this study, we aimed to evaluate the role of the LV twodimensional (2-D) strain in predicting the progression of MS because the estimation of the progression of MS can be important to decide the frequency of control visits and to plan optimal management of the patient.