Cross-sectional echocardiographic left ventricular geometry in rheumatic mitral stenosis

The ultrastructural myopathic changes and deranged left ventricular contractile function have been reported in patients with rheumatic mitral stenosis. It is not clear if as a result of these myopathic changes, global left ventricular myocardial remodelling occurs to alter its normal elliptical shape in the absence of qualitative segmental asynchrony. To study the left ventricular cavity shape independent of chamber size, cross-sectional echocardiographically measured longest long axis (L) of the left ventricular cavity in the apical four-chamber view and short axis diameters at the level of tips of the mitral leaflets in the parasternal long axis view (D-1), of the basal cavity (D-2) and the apical segment (D-3) in the apical four-chamber view at end-diastole and their ratio, were studied in 20 patients with isolated rheumatic mitral stenosis. Twenty healthy volunteers matched for age, sex, heart rate, height and body surface area provided the normal control data. The patients with mitral stenosis had shorter long axis diameter (7.2 ± 0.7 vs 7.9 ± 0.5 cm, p < 0.001) and greater short axis/long axis diameter ratios at every level with the most pronounced change in the apical segment of the cavity (D-3L 0.49 ± 0.09 vs 0.40 ± 0.05, p < 0.001). Left ventricular end-diastolic sphericity index was also markedly increased in the patients with mitral stenosis (0.57 ± 0.09 vs 0.40 ± 0.05, p < 0.001). These changes in the left ventricular geometry were associated with reduced fractional shortening (29 ± 6 vs 33 ± 6%, p < 0.05), increased end-systolic volumes (25 ± 11 vs 19 ± 4 ml/m2, p < 0.05) and increased end-systolic wall stress (70 ± 12 kilodynes/cm2 vs 52 ± 16 kilodynes/cm2, p < 0.001). In a prospective evaluation of 35 patients with mitral stenosis, parameters of left ventricular geometry were not related to the severity of mitral stenosis, systolic dysfunction or end-diastolic volumes. The data provide evidence for left ventricular myocardial remodelling in mitral stenosis in the absence of segmental asynchrony.