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nalysis of the transmitral inflow (TMF) pattern is widely used for evaluating left ventricular (LV) diastolic function, 1,2 and provides valuable information for the management of heart failure (HF) in patients with sinus rhythm. In particular, a restrictive TMF pattern has been recognized as an ominous sign of congestive HF with high mortality. On the other hand, utilization of the TMF pattern analysis in patients with atrial fibrillation (AF) has not been established because of the lack of atrial contraction and variability of the heart rate. Because AF is a very common cardiac arrhythmia, noninvasive estimation of the severity of HF with AF is clinically valuable. Recently , the usefulness of the ratio of transmitral peak E-wave velocity to flow propagation velocity (E/Vp) for evaluating LV filling pressure or left atrial pressure in various cardiac diseases with sinus rhythm has been reported. 3-6 In addition, Nagueh et al demonstrated that E/Vp was significantly related to LV filling pressure even in patients with AF. 7 The circulating plasma B-type natriuretic peptide (BNP) concentration is known to be a good neurohormonal marker reflecting the severity of HF, and is elevated in patients with symptomatic or asymptomatic LV dysfunc-tion. 8-14 Although several studies have examined the utility of E/Vp for estimating LV diastolic function, none has investigated the relationship between E/Vp and the BNP concentration in patients with AF. Therefore, the purpose of this study was to investigate whether E/Vp could be valuable for evaluating LV diastolic function and the severity of HF in patients with AF by clarifying the relationships between E/Vp and the New York Heart Association (NYHA) functional class, pulmonary capillary wedge pressure (PCWP) or plasma BNP concentration. Methods Study Population Protocol 1 An initial training study population consisted of 68 patients (44 men, 24 women; mean age, 68±12 years) with chronic AF. The diagnoses of these patients are listed in Table 1. Patients with mitral stenosis, prosthetic mitral valves, and moderate to severe mitral regurgitation assessed by color Doppler echocardiography were excluded. Patients were classified into 5 groups according to the NYHA functional class Background Although analysis of the transmitral inflow (TMF) pattern is widely used for evaluating left ventricular diastolic function and provides valuable information for the management of heart failure (HF) in sinus rhythm, its utility in patients with atrial fibrillation (AF) has not been established. The aim of this study was to investigate the relationship between the ratio of transmitral peak E-wave velocity to flow propagation velocity (E/Vp) obtained by a newly developed dual Doppler system and the plasma B-type natriuretic peptide (BNP) concentration or pulmonary capillary wedge pressure (PCWP) for evaluating the severity of heart failure with AF. Methods and Results In 68 patients with AF, the E/Vp was compared with plasma BNP concentration and PCWP. A cutoff value of ≥1.7 for E/Vp predict...

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