Use of intraventricular dispersion of the peak diastolic flow velocity as a marker of left ventricular diastolic dysfunction in patients with atrial fibrillation

Echocardiographic assessment of left ventricular diastolic function and filling pressure in atrial fibrillation

Diastolic dysfunction has been linked to 2 epidemics: atrial fibrillation (AF) and heart failure. The presence and severity of diastolic dysfunction are associated with an increased risk for first AF and first heart failure in patients with sinus rhythm. Furthermore, the risk for heart failure is markedly increased once AF develops. The evaluation of diastolic function once AF has developed remains a clinical challenge. The conventional use of Doppler echocardiography for the assessment and grading of diastolic dysfunction relies heavily on evaluating the relation of ventricular and atrial flow characteristics. The mechanical impairment of the left atrium and the variable cycle lengths in AF render the evaluation of diastolic function difficult. A few Doppler echocardiographic methods have been proved clinically useful for the estimation of diastolic left ventricular filling pressures in AF, but these appear to be underutilized. Several innovative methods are emerging that promise to provide greater precision in diastolic function assessment, but their clinical utility in AF remains to be established. In conclusion, this review provides an up-to-date discussion of the evaluation of diastolic function assessment in AF and how it may be important in the clinical management of patients with AF.

Combined use of propagation velocity and intraventricular dispersion of E wave velocity for the evaluation of diastolic functions in patients with rheumatoid arthritis

PURPOSE

The aim of this study was to evaluate diastolic functions in patients with rheumatoid arthritis (RA) by propagation velocity and intraventricular dispersion of E wave velocity.

METHODS

Thirty-four patients fulfilling American Rheumatism Association (ARA) criteria for the diagnosis of RA without evidence of cardiac disease and left ventricular systolic dysfunction were enrolled in this study. Echocardiographic examinations were performed for the evaluation of diastolic dysfunction in all patients.

RESULTS

Propagation velocity in RA patients was significantly lower than the control group (42+/-16 cm/s, 54+/-15 cm/s, p=0.002). There was significant intraventricular dispersion of E wave velocity towards the cardiac apex in RA patients (p<0.001) when compared with the controls (p=0.79). There was a significant correlation between intraventricular dispersion of E wave velocity and diastolic dysfunction in the patients in which the duration of illness was longer than 10 years (p<0.001).

CONCLUSION

Structural myocardial abnormalities may cause impaired left ventricular relaxation in RA patients and these changes are correlated with the duration of the disease. Our findings demonstrate that combined use of propagation velocity and intraventricular dispersion of E wave velocity can help the early determination of diastolic functions in the patients with RA.

Mitral annulus velocity in the evaluation of left ventricular diastolic function in atrial fibrillation

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.