Does Exercise Affect Left Atrium Mechanics In Mild Mitral Stenosis?

OBJECTIVE
A non-negligible number of individuals with mild mitral stenosis have exertional symptoms inconsistent with the hemodynamic severity of the disease. We sought to determine whether exercise-induced LA dysfunction occurs in these patients and whether the development of symptoms is related to it.


METHODS
In this observational study, we recruited 46 patients with mild mitral stenosis. After taking the echocardiographic measurements at rest, a maximal exercise stress test was performed. Then, the patients were taken back to the echocardiography laboratory, and the post-exercise measurements were recorded.


RESULTS
Our study cohort had considerably higher LAVI values (mean: 40,52±18,27) than those of a healthy population. In addition, the left atrial reservoir strain (mean: 17,1±8,33) was reduced relative to reference values. Following exercise, the left atrial reservoir strain did not change. Nonetheless, trans-mitral pressure gradients and systolic pulmonary artery pressure increased. Post-exercise mean trans-mitral gradient was the only predictor of symptom development in patients with MS.


CONCLUSION
The LA reservoir strain is reduced even in individuals with mild MS. Exercise is not associated with an additional decline in LA reservoir function in mild stenosis. According to our knowledge, our study is the first to investigate the effect of exercise on left atrial mechanics in MS.