P663Isovolumic myocardial acceleration, new index of right ventricular function after percutaneous mitral valvuloplasty

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Objectives :In mitral stenosis, Right ventricular (RV) function may be affected either by rheumatic process or due to pulmonary vascular alterations.The aim of this study was to determin if isovolumic myocardial acceleration (IVA) measured by tissue Doppler imaging (DTI) of tricuspid annulus could be used in detection of RV function immediately after percutaneous mitral valvuloplasty (PMV).Patients and methods: The current study enrolled 108 patients with chronic rheumatic mitral stenosis in sinus rhythm. Conventional echocardiographic parameters, mitral valve area (MVA), transmitral diastolic gradient, pulmonary artery pressure (PAP), RV fractional shortening (RVFS%), tricuspid annular plane systolic excursion (TAPSE). TDI-derived systolic velocities of tricuspid annulus, isovolumic myocardial acceleration(IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sm) and RV Tei index were calculated to all patients befor and after (one day) PMV.Results: TAPSE, RVFS% and Sm were relatively higher following PMV but did not attain statistical significance. TDI-derived IVA, IVV index were found to be significantly increased after PMV from 1.71+0.54 m/s2 to 3.27+0.22 m/s2, and from 0.11+0.04 cm/s to 0.14+0.06 cm/s respectivly with (P <0.001) for all. RV Tei index significantlly deceased from 0.49+0.025 to 0.31+0.21 (P < 0.01). Significant negative correlation could be established between IVA and PAP (before and after PMV) (r = -0.61, r=-0.58 respectively), Tei index (r = -0.72) and mean transmitral diastolic gradient (r = -0.74), whereas significant positive correlation was established between IVA and MVA (r = 0.68) with p<0.0001 for all correlations.Conclusion:TDI- derived IVA can be used as reliable, non invasive parameter to detect early improvement of RV function following PMV.

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