Evaluation of left atrial filling using systolic pulmonary venous flow velocity measurements in patients with atrial fibrillation

Abstract

SummaryBuckground: The pattern of pulmonary venous flow velocity is useful for understanding the hemodynamic relationship between the left atrium and left ventricle in patients with a variety of diseases, and the systolic flow wave, in particular, is considered a clinically important parameter that reflects left atrial filling.Hypothesis: The study was undertaken to determine whether systolic pulmonary venous flow velocity patterns can be used to evaluate left atrial filling in patients with atrial fibrillation.Methods: We performed transesophageal pulsed Doppler echocardiography and cardiac catheterization in 34 patients with chronic atrial fibrillation ( 10 with hypertrophic cardiomyopathy, 5 with dilated cardiomyopathy, 7 with previous myocardial infarction, and 12 with isolated atrial fibrillation) and 15 normal controls in sinus rhythm.Results: Mean pulmonary capillary wedge pressure, Vwave height in the pulmonary capillary wedge pressure curve, and left ventricular end-diastolic pressure were significantly higher in the hypertrophic cardiomyopathy and dilated failing heart (previous myocardial infarction and dilated cardiomycpathy) groups than in the isolated atrial fibrillation and normal groups. The peak velocity and time-velocity integral of the systolic pulmonary venous flow velocity, and percent left atrial emptying fraction were significantly lower in the dilated failing heart group than in the isolated atrial fibrillation, hypertrophic cardiomyopathy, and normal groups. The peak velocity and time-velocity integral of the systolic pulmonary venous flow velocity, percent left atrial emptying fraction, and Vwave height were comparatively constant when the preceding R-R intervals were relatively stable in the isolated atrial fibrillation group and in 4 of the 10 patients with hypertrophic cardiomyopathy. However, changes in these variables correlated with the preceding R-R interval in all patients with dilated failing hearts and in 6 of the 10 patients with hypertrophic cardiomyopath y.Conclusion: Transesophageal pulsed Doppler echocardiographic measurements of systolic pulmonary venous flow velocity are valid indicators of left atrial filling in patients with atrial fibrillation.

Prognostic Value of Tricuspid Annular Tissue Doppler Velocity in Heart Failure with Atrial Fibrillation

“…13 The presence of AF seems to result in early alteration of LV systolic and diastolic function, which in turn causes impaired contractility and diastolic LV stiffness. 4,5,[17][18][19] In addition to effects that cause ventricular dysfunction, AF is regarded to contribute to the structural and functional remodeling of the atrial myocardium, which is necessary for right-sided HF despite preserved EF. 20 When it comes to the effects of AF on right atrial compliance in animal models, the increased pressure and decreased compliance of the right atrium have been demonstrated during AF.…”

Implication of Left Ventricular Diastolic Dysfunction in Cryptogenic Ischemic Stroke

“…However, E′, DT, and E/e′ ratio, which were independent of atrial effect, were correlated with filling pressure and were used as valuation basis of LVDD. 17,18 Normal LV filling was defined by the presence of e′≥10 cm/s. In patient with mild LVDD (grade I), annular E′ is <10 cm/s, E/e′ ratio is ≤8, or DT is >240 ms.…”

Diastolic Dysfunction in Heart Failure With Preserved Systolic Function: Need for Objective Evidence

“…To distinguish pseudonormal from normal diastolic function, one of the following measures had to be abnormal: 1) PV flow parameters, 2) E/A during Valsalva maneuver, or 3) plasma NT-proBNP concentration measured at the time of echocardiography. In patients with atrial fibrillation, DT was used to classify patients as abnormal relaxation or restrictive diastolic dysfunction, whereas S/D (15)(16)(17) or NT-proBNP (6 -7) was used to classify patients as pseudonormal diastolic dysfunction. Left atrial volume index was analyzed as an independent measure and not included in the classification of DD.…”