Right ventricular diastolic function assessment by Tissue Doppler in mitral stenosis – Correlation with functional capacity

IntroductionEchocardiography forms the cornerstone in the assessment and management of patients with mitral stenosis. We studied right ventricular diastolic function utilizing, Tissue Doppler imaging (TDI) and correlated it with symptom status in patients with moderate to severe mitral stenosis.Methods51 patients with moderate to severe mitral stenosis were classified into asymptomatic (Group I, NYHA class I) and symptomatic (Group II, NYHA class II–III) group. They underwent standard two dimensional echocardiographic assessment with special stress on right ventricular diastolic function using tissue Doppler imaging. Results were based on comparison of patients who were symptomatic and had right ventricular diastolic dysfunction as compared to those who were asymptomatic with similar mitral valve area. Tei index was also calculated in both these groups and compared. The results were analysed by appropriate statistical tests for correlations.ResultsAmong the right ventricular parameters isovolumic relaxation time (IVRT) in (asymptomatic) group I was lower as compared to (symptomatic) group II, (p < 0.05). Symptomatic group had a lower right ventricular E′/A′ as compared to asymptomatic group, (p < 0.001). Confidence interval plot showed minimal overlap suggestive of strong correlation. The mean Tei index value was higher in symptomatic group but did not achieve statistical significance (p > 0.05).ConclusionPatients with moderate to severe mitral stenosis who had symptoms, also had statistically significant right ventricular diastolic dysfunction in our study, compared to their asymptomatic counterparts. Thus routine assessment of right ventricular diastolic function in patients with mitral stenosis is recommended as it precedes symptomatic worsening.