Introduction
Rheumatic mitral stenosis is a leading cause of morbidity in developing countries. It has adverse hemodynamic effects on both pulmonary circulation and left atrium that may not be completely determined by conventional transthoracic echocardiographic techniques. Symptomatic patients with mitral valve area>1.5 cm2comprises a gray zone in management. Therefore, exercise stress testing is recommended in these patients with symptoms discordant with the severity of the stenosis. Left atrial strain analysis with speckle tracking imaging emerges as a promising technique for the evaluation of these hemodynamic effects better. Despite the well-known fact that the left ventricle is spared from the deleterious hemodynamic effects of mitral stenosis, some new research has recently revealed that it might actually be associated with sub-clinical left ventricle dysfunction. The aim of our study is to examine the left atrial and ventricular function both during rest and just after exercise by speckle tracking imaging in patients with mild rheumatic mitral stenosis and ascertain early hemodynamic deterioration.