الفهرس 
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Abstract
Rheumatic heart disease remains a considerable cause of cardio-vascular morbidity and mortality in developing countries where two thirds of world’s population live. Mitral stenosis is the most common valve affection of rheumatic heart disease worldwide.
The left ventricular ejection fraction is the most widely used index of contractile function, but due to the visual component, assessment of endocardial excursion is subjective leading to inter-observer variability.
Speckle-tracking echocardiography is an imaging technique developed as a method to objectively quantify myocardial function and analyzes cardiac motion and deformation by tracking naturally occurring speckle patterns in the myocardium.
This study was a case-control study involving 80 individuals which included 60 patients having mitral stenosis who presented to the outpatient clinics and cath-lab of cardiology department in Ain Shams University Hospitals and 20 healthy volunteers, The patients suffering from mitral stenosis were subdivided into 3 sub-groups:
group (1) 20 Patients having severe mitral stenosis (MV Area less than 1 cm²).
group (2) 20 Patients having moderate mitral stenosis (MV Area more than 1cm² and less than 1.5 cm²).
group (3) 20 Patients having mild mitral stenosis (MV Area more than 1.5 cm²).
A Control group involved 20 healthy volunteers recruited from health care workers in Ain Shams University Hospitals.
The aim of this study was to evaluate the correlation between the severity of mitral stenosis and subclinical LV systolic dysfunction using 2D speckle tracking.
After a detailed history, all patients were assessed clinically followed by M-Mode and 2D echocardiographic assessment, pulsed wave Doppler, tissue Doppler imaging as well as offline speckle tracking echocardiography assessment of LV systolic function (longitudinal strain pattern).
Our study showed that there was a significant difference between the patient and control groups with respect to age and gender.
There was no significance between the patients and control group as regards smoking.
There was a strong significance between patient and control groups as regards the habitat, so we concluded that living in rural areas carries a higher possibility of having mitral stenosis more than urban areas.
There was a significant relationship between the duration of mitral stenosis and its severity. The longer the duration of mitral stenosis, the more severe the mitral stenosis.
A strong positive relation was noticed between the severity of mitral stenosis and both RVSP and LA diameter.
Furthermore, despite preserved LV systolic function, as revealed by conventional echocardiographic assessment, severe mitral stenosis is associated with sub-clinical reduction of systolic function as reflected by the decline of LV GLS
The study concluded that subclinical LV systolic dysfunction is highly prominent in patients having severe mitral stenosis.
The final conclusion is that speckle tracking echocardiography (STE) is a useful echocardiographic tool recommended in patients having mitral stenosis to point out patients with increased probability of cardiac affection in whom earlier and more aggressive intervention may have a significant impact on prognosis.