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Mitral annulus velocity in the evaluation of left ventricular diastolic function in atrial fibrillation
1Heart Research Institute and Division of Cardiology, Department of Internal Medicine, and Department of Bioengineering, Seoul National University College of Medicine, Korea.
Insights
Mitral annulus velocity (E) effectively predicts impaired left ventricular relaxation in atrial fibrillation patients. The E/E ratio also accurately estimates elevated left ventricular filling pressures, aiding diastolic function assessment.
Area of Science:
- Cardiology
- Echocardiography
- Diastolic Function
Background:
- Atrial fibrillation (AF) is a common arrhythmia limiting conventional Doppler index utility for diastolic function assessment.
- Altered left atrial pressure and loss of atrial contraction in AF complicate evaluation.
- Need for reliable methods to assess left ventricular (LV) diastolic function in AF patients.
Purpose of the Study:
- To assess the clinical utility of mitral annulus velocity in evaluating LV diastolic function in patients with atrial fibrillation.
- To determine if mitral annulus velocity can predict impaired LV relaxation and elevated filling pressures in AF.
Main Methods:
- Simultaneous measurement of mitral inflow and mitral annulus velocities (E) with tau in 27 nonrheumatic AF patients.
- Correlation analysis between Doppler indexes (deceleration time, E, E) and tau.
- Assessment of E/E ratio correlation with LV filling pressure.
Main Results:
- Peak diastolic mitral annulus velocity (E) correlated significantly with tau (r = 0.51, P =.007).
- E <8 cm/s predicted prolonged tau (>/=50 ms) with 73% sensitivity and 100% specificity.
- E/E ratio correlated strongly with LV filling pressure (r = 0.79, P <.001).
- E/E ratio >/=11 predicted elevated LV filling pressure (>/=15 mm Hg) with 75% sensitivity and 93% specificity.
Conclusions:
- Mitral annulus velocity (E) is a useful parameter for detecting impaired LV relaxation in AF.
- The E/E ratio effectively estimates LV filling pressure in AF patients.
- Mitral annulus velocity provides valuable insights into diastolic function despite the presence of atrial fibrillation.
Abstract:
This study assessed the clinical utility of mitral annulus velocity in the evaluation of left ventricular diastolic function in patients with atrial fibrillation. Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice. The clinical usefulness of conventional Doppler indexes is limited in atrial fibrillation because of the altered left atrial pressure and loss of synchronized atrial contraction. Mitral inflow and mitral annulus velocities were measured simultaneously with tau in 27 patients with nonrheumatic atrial fibrillation at the cardiac catheterization laboratory. Among deceleration time of mitral inflow, peak mitral inflow velocity (E), and peak diastolic mitral annulus velocity (E), only E correlated with tau (r = 0.51, P =.007). Prolonged tau (>/=50 ms) could be predicted by E <8 cm/s with a sensitivity of 73% (16 of 22) and a specificity of 100% (5 of 5). The E/E ratio correlated with left ventricular filling pressure (r = 0.79, P <.001). The E/E ratio of >/=11 could predict elevated left ventricular filling pressure (>/=15 mm Hg) with a sensitivity of 75% (9 of 12) and a specificity of 93% (14 of 15). Mitral annulus velocity is useful in the detection of impaired left ventricular relaxation and estimation of filling pressure even in patients with atrial fibrillation.