Echocardiographic diastolic function assessment is of modest utility in patients with persistent and longstanding persistent atrial fibrillation. (7th December 2015)

• Record Type: Journal Article
• Authors: Kohári, Mária; Okada, David R.; Gaztanaga, Larraitz; Zado, Erica; Marchlinski, Francis E.; Callans, David J.; Han, Yuchi
• Is Part Of: IJC heart & vasculature. Volume 9(2015)
• Page Start: 89
• Page End: 94
• Publication Date: 2015-12-07
• Subjects: AF atrial fibrillation -- HF heart failure -- LAP left atrial pressure -- RFA radiofrequency catheter ablation -- TTE transthoracic echocardiography -- LA left atrium -- LAA left atrial area -- LAV left atrial volume -- LAVi indexed left atrial volume -- E early transmitral diastolic inflow -- DT deceleration time -- PVS pulmonary vein systolic flow velocity -- PVD pulmonary vein diastolic flow velocity -- E/E′ ratio of early peak transmitral inflow to mitral annular motion velocity; Persistent atrial fibrillation -- Diastolic dysfunction -- Echocardiography; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2015.10.004
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Background: Detection of concurrent diastolic dysfunction (DD) may be beneficial in patients with persistent and longstanding persistent atrial fibrillation (AF). The role of transthoracic echocardiography (TTE) in assessing DD in patients with AF has not been well characterized. We sought to determine the utility of TTE in detecting elevated left atrial pressure (LAP) in patients with persistent and longstanding persistent non-valvular AF using directly measured LAP as the reference standard. Methods: We retrospectively studied 157 patients with persistent AF and preserved left ventricular ejection fraction who underwent pulmonary vein isolation (PVI). LAP was determined in conjunction with trans-septal puncture at the time of catheter ablation. TTE was performed 1 day after PVI and included two dimensional, pulse wave spectral Doppler and tissue Doppler assessments. Results: The clinical parameter that strongly correlated with elevated LAP is longstanding persistent AF. Four strongest TTE parameters identified to moderately correlate with LAP include 1. left atrial minimum volume (LAVmin), 2. peak velocity of early mitral diastolic inflow velocity (E), 3. pulmonary vein systolic flow velocity (PVS), and 4. ratio of early diastolic transmitral inflow velocity to mitral annular velocity at the lateral site (E/E′ lateral). Conclusion: Accurate assessment of diastolic dysfunction in patients with persistent and longstanding persistent AF is difficult using TTE. A combination of LAVmin, PVS, and E might be helpful to determine elevated LAP.