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Is echocardiography valid and reproducible in patients with atrial fibrillation? A systematic review
Dipak Kotecha1,2,3, Mohamed Mohamed4, Eduard Shantsila1
1University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK.
Insights
Echocardiography effectively identifies diastolic dysfunction in atrial fibrillation (AF) using specific cardiac cycles. Elevated E/e' ratios indicate impaired prognosis, though systolic function data remains limited.
Area of Science:
- Cardiology
- Medical Imaging
- Atrial Fibrillation Research
Background:
- Echocardiography is crucial for managing atrial fibrillation (AF).
- Assessing left ventricular (LV) function via echocardiography in AF patients requires validated methods.
- Understanding diastolic and systolic function is key to predicting AF prognosis.
Purpose of the Study:
- To systematically review the validity and reproducibility of echocardiographic LV systolic and diastolic function in AF.
- To determine optimal echocardiographic acquisition methods for AF patients.
- To evaluate the clinical significance of echocardiographic parameters in AF.
Main Methods:
- Systematic literature search of online databases (1960-August 2015).
- Inclusion of 32 studies involving 1,968 AF patients.
- Analysis of echocardiographic parameters including E/e', IVRT, E/Vp, and pulmonary vein flow.
Main Results:
- Diastolic parameters showed correlation with invasive pressures and good reproducibility (e.g., E/e' r=0.47-0.79).
- Elevated E/e' (>15) correlated with reduced functional capacity, quality of life, and worse prognosis.
- Systolic function data were limited; optimal acquisition requires controlled heart rate and consistent RR intervals.
Conclusions:
- Echocardiography, with careful cycle selection, is valid for identifying diastolic dysfunction in AF.
- E/e' serves as an independent marker of clinical status and prognosis in AF.
- Further research is needed to validate systolic function assessment and clinical variability.
Aims:
Echocardiography is vital in the routine assessment and management of atrial fibrillation (AF). We performed a systematic review of the validity and reproducibility of echocardiographic left ventricular systolic and diastolic function in AF, and optimal acquisition methods.
Methods And Results:
Online databases were searched for studies in patients with AF at the time of echocardiography (1960 to August 2015), prospectively registered with PROSPERO (CRD42015025297). The systematic review included 32 studies from 3 066 search results (1 968 patients with AF). Average age was 67 years, 33% were women, mean LVEF 53% (±10%), and average E/e' 11.7 (±2.7). Data on the validity and reproducibility of systolic indices were extremely limited. In contrast, diastolic parameters demonstrated correlation with invasive filling pressure and adequate reproducibility: E/e' (n = 444) r = 0.47 to 0.79; IVRT (n = 177) r = -0.70 to -0.95; E/Vp` (n = 55) r = 0.63 and 0.65; pulmonary vein diastolic flow (n = 67) r = -0.80 and -0.91. Elevated E/e' (>15) was associated with functional capacity, quality of life, and impaired prognosis. For optimal acquisition in AF patients, cardiac cycles with controlled heart rate (<100 beats/min) and similar preceding and pre-preceding RR intervals are required. Cardiac cycle length and equivalence were more important than the number of beats averaged.
Conclusion:
With careful selection of appropriate cardiac cycles, echocardiography is a valid tool to identify diastolic dysfunction in AF, and E/e' is an independent marker of clinical status and adverse prognosis. However, data on systolic function was extremely limited and requires further prospective study and assessment of variability in clinical practice.