Mitral Annulus Velocity in the Evaluation of Left Ventricular Diastolic Function in Atrial Fibrillation,☆☆,

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Abstract

This study assessed the clinical utility of mitral annulus velocity in the evaluation of left ventricular diastolic function in patients with atrial fibrillation. Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice. The clinical usefulness of conventional Doppler indexes is limited in atrial fibrillation because of the altered left atrial pressure and loss of synchronized atrial contraction. Mitral inflow and mitral annulus velocities were measured simultaneously with tau in 27 patients with nonrheumatic atrial fibrillation at the cardiac catheterization laboratory. Among deceleration time of mitral inflow, peak mitral inflow velocity (E), and peak diastolic mitral annulus velocity (E ́), only E ́ correlated with tau (r = 0.51, P = .007). Prolonged tau (≥50 ms) could be predicted by E ́ <8 cm/s with a sensitivity of 73% (16 of 22) and a specificity of 100% (5 of 5). The E/E ́ ratio correlated with left ventricular filling pressure (r = 0.79, P < .001). The E/E ́ ratio of ≥11 could predict elevated left ventricular filling pressure (≥15 mm Hg) with a sensitivity of 75% (9 of 12) and a specificity of 93% (14 of 15). Mitral annulus velocity is useful in the detection of impaired left ventricular relaxation and estimation of filling pressure even in patients with atrial fibrillation. (J Am Soc Echocardiogr 1999;12:927-31.)

Section snippets

Subjects

Left ventricular pressure measurement and Doppler examination were performed simultaneously in patients with nonrheumatic atrial fibrillation who were undergoing clinically indicated left ventriculography, coronary angiography, aortography, or electrophysiologic study between May 1997 and September 1998 at the Seoul National University Hospital cardiac catheterization laboratory. Patients with valvular stenosis, significant valvular regurgitation, unstable angina, regional wall motion

Mitral Annulus Velocity and Rate of Relaxation (tau)

Among deceleration time of mitral inflow, E, and E ́, only E ́ correlated with tau (r = 0.51, P = .007) (Figure 1).

. Correlation between tau and E ́. E ́ peak diastolic mitral annulus velocity.

Five patients with a mean tau of <50 ms showed mean E ́ of 10.8 ± 3.0 cm/s, and 22 patients with a mean tau of ≥50 ms showed a mean E ́ of 7.2 ± 1.7 cm/s (P < .05). E ́ <8 cm/s was a highly specific index of prolonged rate of myocardial relaxation (sensitivity 73%: 16 of 22 patients, specificity 100%: 5 of

DISCUSSION

Despite the clinical prevalence of atrial fibrillation, conventional Doppler mitral inflow and pulmonary venous flow indexes used in the evaluation of left ventricular diastolic function could not be applied in atrial fibrillation.

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Supported in part by grant 02-1997-029-0 from the Seoul National University Hospital.

☆☆

Reprint requests: Dae-Won Sohn, MD, Division of Cardiology, Department of Internal Medicine, Seoul National University, College of Medicine, 28 Yungun-Dong, Chongno-Gu, Seoul 110-744, Korea.

0894-7317/99 $8.00 + 0  27/1/101005

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