Parameters of speckle tracking echocardiography in right atrial fibrosis of patients with rheumatic mitral stenosis: Focusing on right atrial stiffness.

BACKGROUND

In rheumatic mitral stenosis (RMS), left atrial pressure elevation can lead to right heart dysfunction and fibrosis. The relationship between speckle-tracking echocardiography (STE) right-heart parameters, right atrial fibrosis, and its histological confirmation, remains unclear.

METHODS

46 RMS patients (mean age of 53.0 ± 8.9 years, 67 % females) were enrolled. The exclusion criteria were the presence of moderate or severe aortic valve diseases, rheumatic tricuspid lesions and poor acoustic windows. RA tissue specimens were collected during the operation in RMS patients to analyze the degree of myocardial fibrosis. Echocardiographic evaluations and histological analysis of right atrial (RA) tissue were performed. Correlations between parameters and RA fibrosis were analyzed.

RESULTS

RA fibrosis was strongly correlation with RAsr (r = -0.860, P < 0.001). ROC analysis confirmed that RA stiffness (E/e'/RAsr) (AUC = 0.934, 95 %CI: 0.843-1.000) and STREI index (2 × RVFLWS + RAsr) (AUC = 0.802, 95 %CI: 0.672-0.933) had good diagnostic efficacy. RA fibrosis was verified histologically.

CONCLUSION

To a certain degree, RAsr serves as an indicator mirroring the extent of right atrial fibrosis. In the context of RMS patients, both RA stiffness and the STREI index emerge as potential harbingers of RA fibrosis, playing a significant role in unravelling the underlying mechanisms of disease progression and informing the formulation of efficacious treatment strategies.