Simultaneous Doppler Tracing of Transmitral Inflow and Mitral Annular Velocity as an Estimate of Elevated Left Ventricular Filling Pressure in Patients With Atrial Fibrillation

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp nalysis of the transmitral inflow (TMF) and of the tissue Doppler imaging (TDI)-derived mitral annular velocities is commonly used for evaluating left ventricular (LV) filling pressure, 1,2 and these measures provide valuable information for the management of patients with heart failure (HF) and sinus rhythm. In particular, the ratio of the early transmitral peak velocity to the early mitral annular velocity (E/e'), which is used for evaluating LV filling pressure, is widely used in the clinical setting. The E/e' range from 8 to 15 is recognized as a gray or indeterminate zone for the estimation of LV filling pressure. 2,3 Furthermore, the measurement of the time interval between the onset of E and the onset of e' (TE-e') has been proposed as another calculation using E and e' that can predict LV filling pressure. 4-9 In addition, the clinical utility of TE-e' in patients with normal systolic function and an indeterminate E/e' has been reported. 10 In contrast, the utilization of TMF and TDI 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. Recently, the usefulness of the simultaneous recording of the ratio of early transmitral peak velocity to flow propagation velocity (E/Vp) and E/e', using a dual Doppler system, for the assessment of LV filling pressure in patients with AF was reported. 11-13 The usefulness of TE-e' obtained by simultaneous recording of the onset of E and e' for the assessment of LV filling pressure in patients with AF, however, was not evaluated.The purpose of the present study was therefore to investigate the following: (1) the usefulness of TE-e' in patients with AF for the assessment of LV filling pressure using the simultaneous recording of TMF and TDI with a dual Doppler system; and (2) the added benefit of using TE-e' to predict LV filling pressure, in addition to the measurement of E/e'. The time interval between the onset of early transmitral flow velocity (E) and that of early diastolic mitral annular velocity (e') (TE-e') is a good predictor of elevated left ventricular (LV) filling pressure in patients with sinus rhythm. Although the evaluation of LV filling pressure using E/e' has been challenging in atrial fibrillation (AF), the usefulness of TE-e' is unknown.

Echocardiographic Evaluation of Left Ventricular Diastolic Function: an Update

“…b A patient with impaired LV relaxation and elevated LV filling pressures where T E-e′ =38 ms. Pulmonary artery systolic pressure was elevated at 40 mmHg ratio in patients with atrial fibrillation [32]. Likewise, singlebeat acquisition of mitral E and annular e′ velocities resulted in a better correlation with plasma BNP and mean wedge pressure in patients with atrial fibrillation and normal EF than an E/e′ ratio obtained by velocity averaging from nonsimultaneous beats [33] .…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…przerost lewej komory) i/lub umożliwiając ocenę dysfunkcji rozkurczowej. Zmniejszenie wczesnorozkurczowej prędkości ruchu mięśnia sercowego w tkankowej echokardiowww.kardiologiapolska.pl grafii doplerowskiej (e') odzwierciedla zaburzenia relaksacji lewej komory, natomiast stosunek E/e' koreluje z inwazyjnymi pomiarami ciśnienia napełniania lewej komory [230][231][232][233][234]. Oznaczenia stężenia peptydów natriuretycznych są częścią diagnostycznej oceny HFpEF [222], ale stężenie peptydów natriuretycznych u pacjentów z AF również jest zwiększone, a optymalna diagnostyczna wartość progowa pozostaje nieznana [235].…”

Impact of Left Ventricular Diastolic Dysfunction on Outcome of Catheter Ablation for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

“…Although echocardiography during AF can be inaccurate, E/e' is useful in the estimation of LV filling pressure even in patients with AF. 24, 25 There were no changes in LV diastolic parameters on tissue Doppler imaging following electrical cardioversion in patients with persistent AF, 26 which means that these parameters were used equally in the patients with SR and AF. Fourth, this was an analysis of a small number of patients and a small number of events.…”