CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 294 AFRICA Results This study included 81 patients with rheumatic MS, and of these, 58 had associated MR. The mean age of the patients was 47.40 ± 12.30 years and showed female predominance (females constituted 79% of the study patients). The patients’ mean BSA was 1.87 ± 0.20 m2 and mean heart rate was 78.52 ± 15.03 beats per minute. The majority of the patients (about 76.5%) were newly diagnosed with RHD (Table 1). The echocardiography measurements of the patients are presented in Table 1. The mean MVA was 1.29 ± 0.48 cm2, and the most frequent tricuspid and mitral regurgitation grade was grade II (45.3 and 32.1% of patients, respectively). The patients’ mean ejection fraction was 63.28 ± 5.12%, mean RV function by tricuspid annular plane systolic excursion (TAPSE) was 19.07 ± 2.98 mm, while the mean LA function was 33 ± 15% (Table 1). According to echocardiographic assessment of valve stenosis, Table 1. Echocardiography measurements of the study patients (n = 81) Variables Values Mitral valve, mean ± SD MVA plan (cm2) 1.29 ± 0.48 MPG (mmHg) 10.38 ± 6.25 PHT 183.4 ± 62.85 PASP (mm Hg) 46.78 ± 15.81 TR grades, n (%) Absent 2 (2.5) I 23 (28.4) II 44 (45.3) III 9 (11.1) IV 3 (3.7) MR grades, n (%) Absent 23 (28.4) Grade I 10 (12.3) Grade II 26 (32.1) Grade III 16 (19.8) Grade IV 6 (7.4) LV measurements, mean ± SD EF % 63.28 ± 5.12 IVSd (ml) 9.05 ± 1.54 LVPWd (ml) 8.95 ± 1.40 LVESD (ml) 31.49 ± 4.06 LVEDD (ml) 48.75 ± 4.91 LVMI (g/m2) 82.09 ± 19.93 RWT (cm) 0.37 ± 0.07 RV measurements, mean ± SD TAPSE (mm) 19.07 ± 2.98 RVD (ml) 32.99 ± 4.98 LA area, mean ± SD LAD (ml) 51.42 ± 7.8 LAA S4V (ml) 29.86 ± 8.32 LAA S2V(ml) 25.18 ± 7.77 AvLS (ml) 6.40 ± 0.94 LAA D4V (ml) 23.84 ± 8.76 LAA D2V (ml) 19.90 ± 7.90 avLD (ml) 5.86 ± 1.05 LA volume, mean ± SD LAvolmax (ml) 101.2 ± 42.78 LAvolmin (ml) 71.01 ± 39.84 LAVImax (ml/m2) 54.32 ± 23.9 LAVImin (ml m2) 38.04 ± 21.8 LA function (%) 33 ± 15 MVA plan: mitral valve area measured using planimetry, MPG: mean pressure gradient, PHT: pressure half-time, SPAP: pulmonary systolic pressure, MR: mitral regurgitation, TR: tricuspid regurgitation, EF: ejection fraction, IVSd: interventricular septum diameter, LVPWd: left ventricular posterior wall diameter, LVESD: left ventricular end-systolic diameter, LVEDD: left ventricular end-diastolic diameter, LVMI: left ventricular mass index, RWT: relative wall thickness, TAPSE: tricuspid annular plane systolic excursion, RVD: right ventricular diameter, LAD: left atrial diameter, LAA S4V: left atrial area systolic four shaper view, LAA S2V: left atrial area systolic two shaper view, LAA D4V: left atrial area diastolic four shaper view, LAA D2V: left atrial area diastolic two shaper view, LAvolmax: maximum left atrial volume, LAvolmin: minimum left atrial volume, LA function: left atrial function. AvLS: average length of systole, avLD: average length of diastole, LAVI: left atrial volume index. Table 2. Demographic and echocardiographic characteristics of the studied patients according to the different MS grades Variables Mild MS (n = 24) Moderate MS (n = 26) Severe MS (n = 31) p-value Age (years), mean ± SD 48 ± 10.99 46.54 ± 11.85 47.65 ± 13.89 0.93a Gender, n (%) Male 1 (4.2) 5 (19.2) 11 (35.5) 0.002b Female 23 (95.8) 21 (80.8) 20 (64.5) BSA, mean ± SD 1.88 ± 0.17 1.87 ± 0.24 1.88 ± 0.20 0.94a Tricuspid regurgitation Normal morphology 24 (100) 25 (96.2) 29 (9.3) 0.38 F Rheumatic TR 0 (0) 1 (3.8) 3 (9.7) TR grades, n (%) Absent 2 (8.3) 0 0 0.01F I 12 (50) 7 (26.9) 4 (12.9) II 10 (41.7) 15 (57.7) 19 (61.3) III 0 3 (11.5) 6 (19.4) IV 0 1 (3.8) 2 (6.5) LV measurements, mean ± SD EF % 64.25 ± 5.30 63.62 ± 4.44 62.26 ± 5.49 0.46a IVSd (ml) 9.21 ± 1.77 8.96 ± 1.4 9.00 ± 1.51 0.87a LVPWd (ml) 8.96 ± 1.57 8.73 ± 1.28 9.13 ± 1.38 0.54a LVESD (ml) 31± 4.55 31.62 ± 3.19 31.77 ± 4.40 0.44a LVEDD (ml) 48.79 ± 5.54 48.92 ± 4.26 48.58 ± 5.06 0.91a LVMI (g/ m2) 82± 21.63 81.65 ± 18.85 82.52 ± 20.09 0.85a RWT (cm) 0.38 ± 0.07 0.36 ± 0.05 0.38 ± 0.08 0.60a RV measurements, mean ± SD RVF (TAPSE) (mm) 20.13 ± 3.94 19.31 ± 2.84 18.06 ± 1.77 β < 0.001a RVD (ml) 30.04 ± 3.24 33.19 ± 4.66 35.10 ± 5.34 β < 0.001a LA area, mean ± SD LAD (ml) 46.79 ± 7.27 52.38 ± 7.71β 54.19 ± 6.9 β < 0.001a LA area S4 (ml) 25.45 ± 9.27 30.77 ± 8.03 β 32.50 ± 6.43 β < 0.001a LA area S2 (ml) 20.74 ± 6.10 25.15 ± 6.49 β 28.65 ± 8.32 β < 0.001a AvLS (ml) 5.79 ± 0.75 6.51 ± 0.84 β 6.78 ± 0.93 β < 0.001a LA area D4 (ml) 17.86 ± 9.52 25.07 ± 7.56 β 27.44 ± 6.64 β < 0.001a LA area D2 (ml) 14.30 ± 6.01 20.31 ± 6.27 β 23.88 ± 8.01 β < 0.001a avLD (ml) 5.02 ± 0.82 6.02 ± 0.91 β 6.37 ± 0.95 β < 0.001a LA volume, mean ± SD LAvolmax (ml) 80.03 ± 46.46 101.33 ± 35.03β 117.45 ± 39.6β < 0.001a LAvolmin (ml) 46.22 ± 40.18 72.91 ± 30.87β 88.61 ± 37.22β < 0.001a LAVImax (ml/ m2) 43.75 ± 29.63 54.07 ± 17.11β 62.71 ± 21.1β < 0.001a LAVImin (ml/ m2) 25.6 ± 25 38.6 ± 15β 47.2 ± 19.5β < 0.001a LA function 0.47 ± 0.14 0.29 ± 0.14 β 0.26 ± 0.10 β < 0.001a BSA: body surface area, RHD: rheumatic heart disease, TR: tricuspid regurgitation, MS: mitral stenosis, EF: ejection fraction, IVSd: interventricular septum diameter, LVPWd: left ventricular posterior wall diameter, LVESD: left ventricular end-systolic diameter, LVEDD: left ventricular end-diastolic diameter , LVMI: left ventricular mass index, RWT: relative wall thickness, TAPSE: tricuspid annular plane systolic excursion, RVD: right ventricular diameter, LAD: left atrial diameter, LAA S4V: left atrial area systolic four shaper view, LAA S2V: left atrial area systolic two shaper view, LAA D4V: left atrial area diastolic four shaper view, LAA D2V: left atrial area diastolic two shaper view, LAvolmax: maximum left atrial volume, LAvolmin: minimum left atrial volume, LA function: left atrial function, AvLS: average length of systole, avLD: average length of diastole, LAVI: left atrial volume index. ap-values are based on the Kruskal–Wallis test, bp-values are based on the chisquared test. Statistical significance at p < 0.05, Fp-values are based on the Fisher exact test. Statistical significance at p < 0.05. Values with superscriptβ are different from mild MS group.
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