CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 292 AFRICA Correlation between mitral valve area and left atrial function in rheumatic mitral valve stenosis patients Ahmed Fareed, Mohamed Hamed, Fathy Makaldy, Omar Saleh Abstract Background: Rheumatic heart disease (RHD) continues to be one of the leading causes of cardiovascular morbidity and mortality. The mitral valve frequently develops mitral stenosis (MS), and it is the most prevalent valve lesion in patients with chronic RHD. Left atrial (LA) functional impairment is associated with rheumatic MS. Aim: The aim of this study was to evaluate the association between LA function and mitral valve area (MVA) in rheumatic MS patients, and to assess the echocardiographic parameters in sinus rhythm and atrial fibrillation (AF) patients. Methods: This was a cross-sectional, descriptive study that involved patients with rheumatic MS. Patients underwent a standard 12-lead electrocardiogram and echocardiographic examination. MVA was assessed and correlated with LA function. Comparison was made between sinus rhythm and AF patients. Results: Eighty-one patients with rheumatic MS were included in this study, with 71.6% of them having associated MR. MVA showed a statistically highly significant positive correlation with LA and right ventricular (RV) function, and a statistically significant/highly significant negative correlation with their dimensions. A higher percentage of patients with severe MS was in AF (58.1%). Conclusion: There was a positive correlation between LA function and MVA in rheumatic MS patients. AF was related to the severity of MS. Keywords: rheumatic heart disease, mitral stenosis, mitral valve area, left atrial function, atrial fibrillation Submitted 28/10/22, accepted 15/11/22 Published online 13/12/22 Cardiovasc J Afr 2023; 34: 292–298 www.cvja.co.za DOI: 10.5830/CVJA-2022-059 Rheumatic heart disease (RHD) is a cardiac disease affecting the endocardium, myocardium and pericardium, with the subsequent potentiality of their permanent damage.1 RHD occurs as a result of rheumatic fever (RF), which is caused by group A β-haemolytic streptococcus infection.2 Developing countries show a high prevalence of RF due to overcrowding and poor sanitation.3 Among the rheumatic cardiac complications, rheumatic mitral stenosis (MS) is characterised by a thickening of the mitral valve leaflets, commissural fusion and shortening and fusion of the chordae tendineae.4 This stenosis results in impeded left atrial (LA) to left ventricular (LV) blood flow, with subsequent blood stagnation in the left atrium. This stagnation causes elevation of pressure in the left atrium and pulmonary veins, pulmonary oedema and elevation of pressure in the pulmonary artery and the right side of the heart.5 Atrial fibrillation (AF) is a common complication of rheumatic MS, which conveys a poor prognosis.6 AF is found in more than 80% of patients with MS and systemic embolism.7 Rheumatic MS is mainly diagnosed by clinical examination and echocardiography.8 Echocardiography allows objective monitoring of the affected valve, the chamber size and function, and pulmonary artery pressure. It offers detailed data, which helps to determine the best management strategy.9 RF is an ongoing problem in Egypt and is predominantly complicated by cardiac involvement. One recent study conducted in a large Egyptian cardiac centre announced that 46.1% of the cardiac operations performed in the centre during a period of 20 years were for RHD, and about 360 new RF/RHD cases were identified each year.10 Despite these critical figures, few studies in Egypt evaluated the impact of mitral valve area (MVA) on LA function and AF prevalence in rheumatic MS patients. This study aimed to detect the relationship between LA function and MVA in rheumatic MS patients, and to assess the echocardiographic parameters in sinus rhythm patients and AF patients. Methods This cross-sectional, descriptive study was performed after the approval of the regional ethics committee (No. 2019.6.11/3879) and in accordance with the Declaration of Helsinki on rheumatic MS patients who were referred for echocardiography in the Suez Canal University (SCU) Hospital during the period from July 2019 to September 2020. From each patient, written, informed consent was obtained. Adult patients with MVA < 2.5 cm2 and preserved LV systolic function were eligible for the study. Those excluded were LV systolic dysfunction patients (ejection fraction < 50%), those with ischaemic heart disease, more than moderate aortic valve disease, prosthetic aortic valves, sclerotic MS, electrocardiogram (ECG)- discovered atrioventricular (A-V) conduction abnormalities, and patients with low-quality echocardiographic images. All patients with MS referred for echocardiography in the SCU during the period from July 2019 to September 2020 and fulfilling the inclusion criteria were enrolled. Department of Cardiology, Suez Canal University, Ismailia, Egypt Ahmed Fareed, MD, ahmed_ali1@med.suez.edu.eg Fathy Makaldy, MD Omar Saleh, MD Department of Cardiology, Ismailia General Hospital, Ismailia, Egypt Mohamed Hamed, MSc
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