Is the Ratio of Transmitral Peak E-Wave Velocity to Color Flow Propagation Velocity Useful for Evaluating the Severity of Heart Failure in Atrial Fibrillation?

Abstract

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][4][5][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 dysfunction. [8][9][10][11][12][13][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 PopulationProtocol 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 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 ResultsIn 68 patients with AF, the E/Vp was compared with plasma BNP concentration and PCWP. A cutoff value of ≥1.7 for E/Vp predicted a plasma BNP concentrationl of ≥200 pg/ml, with 80% sensitivity and 84% specificity. Only E/Vp was found to be independently significant by stepwise multilinear regression analysis (r=0.40, p=0.01). PCWP values had g...

Is echocardiography valid and reproducible in patients with atrial fibrillation? A systematic review

“… 11 E/Vp and the deceleration time of PV diastolic flow were each assessed in 2 studies ( n = 55 and n = 67, respectively) and both parameters showed a high degree of correlation with PCWP. 10 , 21 , 22 , 24 Diastolic PV flow was better than mitral indices for estimating PCWP in one study of 35 AF patients. 10 …”

“… 25 Diastolic indices, including E/e’ and E/Vp, have also been shown to correlate with B-type natriuretic peptide (BNP), a biomarker strongly associated with adverse prognosis. 15 , 24 E/e’ was the only echocardiographic variable of LV function related to exercise capacity in 73 patients with AF (multivariate adjusted coefficient β = –0.12; P = 0.032). 17 The same group also showed in one of the only multicentre studies that septal E/e’ was associated with prior ischaemic stroke in 330 AF patients with LVEF >40% (adjusted odds ratio 1.21, 95% CI 1.08–1.37; P = 0.002), unlike clinical and echocardiographic parameters such and age, BNP, or LVEF.…”

“… AF patients with E/e’ >15 have higher mortality, independent of clinical factors. Oyama, 2004 24 68 Non-valvular chronic AF patients. Diastolic validity and reproducibility.…”