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Clinical Utility of Single-Beat E/e' Obtained by Simultaneous Recording of Flow and Tissue Doppler Velocities in Atrial Fibrillation With Preserved Systolic Function

Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan

^_* Reprint requests and correspondence: Dr. Hirotsugu Yamada, Department of Cardiovascular Medicine, Institute of Health Biosciences, University of Tokushima Graduate School, 2-50-1 Kuramoto, Tokushima 770-8503, Japan (Email: yamadah{at}clin.med.tokushima-u.ac.jp).

Objectives: We evaluated the usefulness of the ratio of the early diastolic transmitral flow velocity (E) to the mitral annular velocity (e') calculated from simultaneously recorded E and e' in atrial fibrillation (AF).

Background: The ratio of the E to the e' (E/e') has been reported as a useful index even in AF patients. However, E and e' were measured during different beats in the previous studies.

Methods: Fifty-six AF patients with preserved systolic function (mean age 66 ± 11 years) underwent routine echocardiographic study. The E/e' was calculated from the E and e' simultaneously recorded by the dual Doppler echocardiography. A single-beat E/e' was calculated from simultaneously recorded E and e' when the preceding RR interval/pre-preceding RR interval = 1. Brain natriuretic peptide (BNP) levels were also examined. Twenty-one patients underwent simultaneous pulmonary artery catheterization.

Results: The single-beat lateral E/e' correlated with pulmonary capillary wedge pressure (PCWP) (r = 0.74, p < 0.001). The single-beat lateral E/e' of 11 could predict elevated PCWP (15 mm Hg) with a sensitivity of 90% and a specificity of 90%. The single-beat lateral E/e' also correlated well with the log BNP concentration. The single-beat lateral E/e' of 9.2 predicted a plasma BNP level of 200 pg/ml with 88% sensitivity and 84% specificity.

Conclusions: The single-beat lateral E/e' correlated with plasma BNP level and PCWP in AF patients with preserved systolic function. In addition, the single-beat lateral E/e' (11) was a good predictor of elevated PCWP (15 mm Hg). Dual Doppler echocardiography offers an advantage of providing the single-beat lateral E/e' correctly even in AF patients, for the evaluation of left ventricular diastolic function.

Key Words: atrial fibrillation • diastolic function • Doppler echocardiography

Abbreviations and Acronyms   AF = atrial fibrillation   BNP = brain natriuretic peptide   DT = deceleration time of E wave   E = early diastolic transmitral flow velocity   e' = early diastolic mitral annular velocity   LA = left atrial/atrium   LV = left ventricle/ventricular   LVEF = left ventricular ejection fraction   PCWP = pulmonary capillary wedge pressure   RRp = preceding RR interval   RRpp = pre-preceding RR interval

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