Role of Left Atrial Strain in Assessment of Mitral Stenosis

Abstract

Background: Mitral stenosis is a progressive valvular disorder characterized by narrowing of the mitral valve orifice, most commonly as a consequence of rheumatic heart disease. Echocardiography represents the principal noninvasive imaging modality for the diagnosis, grading, and follow-up of mitral stenosis. Two-dimensional echocardiography enables direct visualization of mitral leaflet morphology, commissural fusion, subvalvular involvement, calcification, and mitral valve area, while Doppler techniques provide essential hemodynamic information, including transmitral pressure gradients and pressure half-time. In addition, advanced echocardiographic techniques, particularly speckle-tracking echocardiography and velocity vector imaging, permit quantitative assessment of myocardial deformation and left atrial function. Left atrial reservoir, conduit, and contractile strain are frequently impaired in patients with mitral stenosis as a result of chronic pressure overload, atrial remodeling, fibrosis, and altered ventricular filling. These parameters may provide additional information regarding disease severity, functional status, procedural outcome, and risk of adverse cardiovascular events. Therefore, integrating conventional two-dimensional and Doppler echocardiography with deformation imaging may improve the comprehensive assessment of mitral stenosis and support clinical decision-making.