DOI: 10.1111/j.1540-8175.2011.01529.x C  2011, Wiley Periodicals, Inc. Assessment of Right Ventricular Endocardial Dysfunction in Mild-to-Moderate Mitral Stenosis Patients Using Velocity Vector Imaging Ozlem Yildirimturk, M.D., F.E.S.C., Fatma Funda Helvacioglu, M.D., Yelda Tayyareci, M.D., Selen Yurdakul, M.D., Saide Aytekin, M.D., F.E.S.C. Division of Cardiology, Florence Nightingale Hospital, Istanbul, Turkey Purpose: Right ventricular (RV) function plays an important role in the development of clinical symp- toms, exercise capacity, prognosis, and survival in patients with mitral stenosis (MS). The purpose of this study was to evaluate global and regional RV systolic functions using a novel technique, VVI, in mild- to-moderate MS patients without clinical symptoms of heart failure. Methods: The study population consisted of 60 patients (mean age 51.7 ± 11.6 years; 85% female) with isolated rheumatic mitral valve stenosis and 40 age- and sex-matched control subjects (mean age 49.1 ± 10.5 years; 76.7% female). Conventional echocardiography, tissue Doppler imaging (TDI), strain (S), and strain rate (SRs) analysis were performed in all patients. Results: Transmitral mean pressure gradient was 6.1 ± 3.0 mmHg and mean mitral valve area was 1.41 ± 0.31 cm 2 in patients with MS. TDI systolic velocity was signifi- cantly lower in MS patients compared to control subjects (0.13 ± 0.03 m/sec vs. 0.17 ± 0.03 m/sec; P < 0.0001). RV-isovolumic acceleration was reduced in MS patients (3.75 ± 1.09 m/sec 2 vs. 4.62 ± 1.0 m/sec 2 ;P = 0.006). RV-myocardial performance index was significantly increased in patients with MS (0.75 ± 0.05 in MS and 0.29 ± 0.04 in controls; P < 0.0001) revealing impaired RV systolic and diastolic function. The mean longitudinal peak systolic S and SR were significantly reduced in patients with MS (P < 0.0001). Conclusion: Our data revealed that RV systolic performance is reduced in patients with mild-to-moderate MS. (Echocardiography 2012;29:25-33) Key words: mitral stenosis, right ventricular function, tissue and strain doppler echocardiography Rheumatic mitral stenosis (MS) is character- ized with commissural fusion, thickening, and re- traction of mitral valve apparatus and leaflets. 1 Although reduced exercise capacity and fatigue are common symptoms in patients with MS, in- creased left atrial (LA) and pulmonary venous pressures are not the only responsible subjects for these symptoms. 2 Right ventricular (RV) func- tion plays an important role in the development of clinical symptoms, exercise capacity, progno- sis, and survival in patients with MS. 3,4 RV systolic dysfunction may result from involvement of my- ocardium itself through rheumatic process or sec- ondary to increased LA pressure and pulmonary hypertension. 5 Conventional two-dimensional (2D) echocar- diography is limited to provide an accurate eval- uation of RV functions because of its asymmet- This study was presented as a poster in EUROECHO 2010, Denmark and as an oral presentation in 25th National Cardi- ology Congress at Istanbul, Turkey. Address for correspondence and reprint requests: Saide Aytekin, M.D., F.E.S.C., Florence Nightingale Hospital, Abide- i Hurriyet cad. No: 290, Postal code: 34381 Caglayan, Sisli, Istanbul, Turkey. Fax: +90-212-2244982; E-mail: saideaytekin@gmail.com rical shape, complex anatomy, narrow acoustic window and geometrical assumptions for volume calculations. 6,7 Imaging methods like radionu- clide ventriculography, contrast right ventriculog- raphy, and cardiac magnetic resonance imaging can be used to evaluate RV volumes and func- tion but they are time consuming and not widely available. 8,9 Tissue Doppler Imaging (TDI) is also used for evaluation of RV systolic function. 10 However, TDI-derived measurements have disadvantage of angle dependency and limited spatial resolu- tion. 11 TDI and Doppler-derived strain (S)/strain rate (SRs) imaging (SRI) are novel techniques that have been shown to be reliable and accu- rate for evaluating global and regional ventric- ular functions. 12,13 TDI is preload and afterload dependent, SRI is affected by changes in after- load, but less- load dependent than conventional parameters. 14–16 Velocity vector imaging (VVI) is a novel 2D S imaging technique, which provides more accu- rate data on regional and global cardiac functions and is angle-independent. 17,18 VVI has been intro- duced to be a reliable method for quantification of regional contractile dysfunction with the ability to detect subclinical systolic dysfunction. 19,20 25