The Interest of the Global Longitudinal Strain in Severe Valve Disease: Moroccan Experience

Abstract

Aims: Valvular heart diseases, primarily mitral stenosis, are a significant concern in Morocco. Early detection of left ventricular systolic dysfunction is crucial, especially in high-prevalence valvular disease populations. This study aims to investigate global longitudinal strain as a more sensitive tool for early detection, potentially providing early warning signs before a decrease in ejection fraction. Additionally, it addresses the gap in the literature, focusing on global longitudinal strain application in the Moroccan population, with a particular emphasis on mitral stenosis and aortic stenosis degenerative but also and above all rheumatic. Study Design:  A descriptive study. Place and Duration of Study: Cardiology department, CHU Ibn Rochd, Casablanca, Morocco, from 2020 to 2023. Methodology: We included 81 individuals, adhering to ESC 2021 criteria, focusing on patients with pure severe mitral stenosis or severe aortic stenosis and preserved LVEF (≥50%). Excluding patients with LVEF<50%, all underwent comprehensive echocardiography, including valvular disease severity evaluation, LVEF assessment by Simpson biplane, and global longitudinal strain, with descriptive analysis conducted using Excel. Results: 51.9% of our patients had severe mitral stenosis, and 48.1% had severe aortic stenosis. Mitral stenosis was mainly rheumatic and aortic stenosis was mainly degenerative.  The global longitudinal strain was the lowest for mitral stenosis with -14.95%, and -15.25% for aortic stenosis. Conclusion: Our Moroccan experience has underscored the significance of global longitudinal strain in assessing valvular heart disease cases with preserved ejection fraction. Our specific focus on mitral stenosis, highly prevalent in our population and exhibiting the most pronounced global longitudinal strain impairment, underscores the value of routine global longitudinal strain measurements in valve disease evaluation, particularly in mitral stenosis. Ongoing patient monitoring will further contribute to prospective, conclusive insights into mitral stenosis management.