Effect of heart rate on hemodynamics in mitral stenosis

ABSTRACT

To assess the effect of heart rate [HR] on haemodynamic parameters in patients with Mitral Stenosis [MS]. The study was conducted at Cardiology department, Lady Reading Hospital, Peshawar from November 2010 to April 2011. Patients with MS, regardless of severity, were included. Patients with severe heart failure, other valvular or structural heart disease were excluded. Echocardiographic parameters were recorded at slow and fast HR. Patients with tachycardia were given beta-blockers and patients with bradycardia were given parenteral Atropine. A total of 60 patients were included, females were 57 [78%]. Mean age was 31 +/- 9 years. Mean slow and fast HR was 77 +/- 12bpm and110 +/- 13 bpm, respectively. Peak mitral valve gradient [PMVG] slow vs. fast HR was 12.8 +/- 4.80 and 14.93 +/- 7.18 mm Hg [p=0.000]. Mean mitral valve gradient [MMVG] at slow vs. fast HR was 6.62 +/- 3.29 and 8.15 +/- 4.88 mm of Hg [p=0.000]. E pulse Doppler [E] at slow vs. fast HR was 168 +/- 35 and 181 +/- 40 cm/s [p=0.013], while E tissue Doppler [E] velocity was 10.47 +/- 2.81 and 10.97 +/- 2.38 cm/s / [P=0.098], respectively. E/E ratio for slow and fast HR was 17 +/- 5.63 vs. 17 +/- 5.41 [P=0.792]. Right ventricular systolic pressure [RVSP] at slow vs. fast HR was44 +/- 16 vs.49 +/- 17.05mm of Hg [P=0.001]. The above parameters had insignificant change with the HR when there was accompanying more than mild MR. Slowing HR in patients with MS significantly decreased PMVG, MMVG and RVSP. LV function did not change significantly with HR. Rate control drugs may be used in preference to improve symptoms in moderate and severe MS