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Echocardiographic diastolic function assessment is of modest utility in patients with persistent and longstanding

Mária Kohári1,2, David R Okada3, Larraitz Gaztanaga1

  • 1Hospital of the University of Pennsylvania, Cardiovascular Division, Philadelphia, PA, United States.

International Journal of Cardiology. Heart & Vasculature
|August 9, 2017
PubMed

Insights

Detecting diastolic dysfunction in atrial fibrillation (AF) patients is crucial. Transthoracic echocardiography (TTE) shows moderate correlation with elevated left atrial pressure (LAP) using specific parameters, aiding diagnosis.

Area of Science:

  • Cardiology
  • Echocardiography
  • Electrophysiology

Background:

  • Diastolic dysfunction (DD) detection is beneficial for patients with persistent and longstanding persistent atrial fibrillation (AF).
  • The utility of transthoracic echocardiography (TTE) in assessing DD in AF patients requires further characterization.
  • This study aimed to evaluate TTE's effectiveness in detecting elevated left atrial pressure (LAP) in non-valvular AF using direct LAP measurements as the gold standard.

Purpose of the Study:

  • To determine the utility of transthoracic echocardiography (TTE) in detecting elevated left atrial pressure (LAP).
  • To assess TTE's role in patients with persistent and longstanding persistent non-valvular atrial fibrillation (AF).
  • To correlate TTE findings with directly measured LAP.

Main Methods:

  • Retrospective study of 157 patients with persistent AF and preserved left ventricular ejection fraction undergoing pulmonary vein isolation (PVI).
  • Left atrial pressure (LAP) measured during trans-septal puncture prior to catheter ablation.
  • Transthoracic echocardiography (TTE) performed one day post-PVI, including 2D, spectral Doppler, and tissue Doppler assessments.

Main Results:

  • Longstanding persistent AF was strongly correlated with elevated LAP.
  • Four TTE parameters moderately correlated with LAP: left atrial minimum volume (LAVmin), early diastolic mitral inflow velocity (E), pulmonary vein systolic flow velocity (PVS), and E/E' lateral.
  • These parameters provide insights into diastolic function in AF patients.

Conclusions:

  • Accurate assessment of diastolic dysfunction in persistent and longstanding persistent AF patients using TTE is challenging.
  • A combination of LAVmin, PVS, and E may assist in identifying elevated LAP.
  • Further research is needed to refine TTE's role in managing AF-related diastolic dysfunction.
Abstract

Keywords:
AF, atrial fibrillationDT, deceleration timeDiastolic dysfunctionE, early transmitral diastolic inflowE/E′, ratio of early peak transmitral inflow to mitral annular motion velocityEchocardiographyHF, heart failureLA, left atriumLAA, left atrial areaLAP, left atrial pressureLAV, left atrial volumeLAVi, indexed left atrial volumePVD, pulmonary vein diastolic flow velocityPVS, pulmonary vein systolic flow velocityPersistent atrial fibrillationRFA, radiofrequency catheter ablationTTE, transthoracic echocardiography

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