Evaluation of right ventricular systolic function in patients with rheumatic mitral stenosis by tissue tricuspid annular displacement technique.

BACKGROUND

Rheumatic mitral stenosis (RMS) can impact right ventricular function. In RMS, abnormal hemodynamics due to mitral valve narrowing can cause right ventricular overload, altering right ventricular systolic function. Accurate assessment is crucial. Instead of its traditional meaning of tissue mitral annular displacement (TMAD), TMAD parameter represents tissue tricuspid annular displacement, and applies to the tricuspid valve. In this study, we used TMAD along with speckle tracking echocardiography (STE) to evaluate right ventricular function in RMS patients and explore its feasibility.

METHODS

A total of 64 patients with RMS who visited The First Affiliated Hospital of Guangxi Medical University from June 2022 to June 2023 were selected as the case group, and 50 healthy people who underwent physical examinations were selected as the control group. All participants underwent echocardiography. TMAD was used to detect relevant parameters, and STE was used to evaluate the right ventricular global longitudinal strain (RVGLS). All participants were divided into a normal right ventricular systolic function group and a right ventricular systolic dysfunction group according to right ventricular fractional area change (RVFAC). The receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy of RVGLS and TMAD parameters, including TMAD at the right ventricular free wall (TMAD1), TMAD at the ventricular septum (TMAD2), TMAD at the midpoint of the tricuspid valve (TMADm) displacement, and percentage of right ventricular longitudinal shortening (TMADm%).

RESULTS

The parameters of RVGLS, TMAD1, TMAD2, TMADm, and TMADm% in the case group were statistically different from those in the control group (P<0.05). Correlation analysis showed that RVFAC was positively correlated with RVGLS, TMAD1, TMAD2, TMADm, and TMADm% (r=0.8081, 0.6752, 0.5968, 0.6617, and 0.6028, respectively; all P<0.001). RVGLS and TMAD had high diagnostic efficacy in identifying right ventricular systolic dysfunction. The area under the ROC curve (AUC) of RVGLS was 0.9066 [95% confidence interval (CI): 0.8532-0.9601], the AUC of TMAD1 was 0.8687 (95% CI: 0.7976-0.9399), the AUC of TMAD2 was 0.8415 (95% CI: 0.7680-0.9151), the AUC of TMADm was 0.8849 (95% CI: 0.8169-0.9528), and the AUC of TMADm% was 0.8349 (95% CI: 0.7574-0.9123).

CONCLUSIONS

RVGLS and TMAD are accurate in evaluating the myocardial function of the right ventricle in patients with RMS. TMAD technology has advantages of simple operation and high measurement efficiency, and can be used as a simple index for evaluating the myocardial function of the right ventricle in patients with RMS, providing a reference for early identification of right heart systolic dysfunction. RVGLS and TMAD have high diagnostic efficacy in identifying right ventricular systolic dysfunction.