Abstract
BackgroundEvidence of diastolic dysfunction (DD) required for the diagnosis of heart failure with preserved ejection fraction (HFpEF) is elusive in atrial fibrillation (AF). Left ventricular (LV) and left atrial (LA) speckle-tracking echocardiography (STE) may provide rhythm independent indications of DD. We aimed to find common LV/LA myocardial mechanics parameters to demonstrate DD, using STE in patients with AF.Methods176 echocardiographic assessments of patients were studied retrospectively by STE. 109 patients with history of AF were divided in three groups: sinus with normal diastolic function (n = 32, ND), sinus with DD (n = 35, DD) and patients with AF during echocardiography (n = 42). These assessments were compared to 67 normal controls. Demographic, clinical, echocardiographic and myocardial mechanic characteristics were obtained.ResultsThe patients with DD in sinus rhythm and patients with AF were similar in age, mostly women, and had cardiovascular risk factors as well as higher dyspnea prevalence compared to either controls or patients with ND. In the AF group, LV ejection fraction (LVEF) (p = 0.008), global longitudinal strain and LA emptying were lower (p < 0.001), whereas LA volumes were larger (p < 0.001) compared to the other groups. In a multivariable analysis of patients in sinus rhythm, LA minimal volume indexed to body surface area (Vmin-I) was found to be the single significant factor associated with DD (AUC 83%). In all study patients, Vmin-I correlated with dyspnea (AUC 80%) and pulmonary hypertension (AUC 90%).ConclusionsVmin-I may be used to identify DD and assist in the diagnosis of HFpEF in patients with AF.
Highlights
Evidence of diastolic dysfunction (DD) required for the diagnosis of heart failure with preserved ejec‐ tion fraction (HFpEF) is elusive in atrial fibrillation (AF)
Current DD echocardiographic recommendations [11] mostly focus on diagnostic criteria for patients in sinus rhythm, whereas DD diagnosis in AF is addressed as “in special populations”, pointing out that maximal left atria (LA) volume may be directly related to AF, and that Doppler assessment of Left ventricular (LV) diastolic function is limited by the variability in cycle length [11]
Conventional 2‐D Doppler echocardiographic characteristics As summarized in Table 2, bi-plane left ventricle ejection fraction (LVEF) was in the normal range (63% ± 4) and similar for all groups
Summary
Evidence of diastolic dysfunction (DD) required for the diagnosis of heart failure with preserved ejec‐ tion fraction (HFpEF) is elusive in atrial fibrillation (AF). More than half of all patients suffering from heart failure (HF) have preserved left ventricle ejection fraction (LVEF) [1,2,3,4,5,6]. Current DD echocardiographic recommendations [11] mostly focus on diagnostic criteria for patients in sinus rhythm, whereas DD diagnosis in AF is addressed as “in special populations”, pointing out that maximal left atria (LA) volume may be directly related to AF, and that Doppler assessment of LV diastolic function is limited by the variability in cycle length [11]. A multitude of parameters are presented that “can be used to predict LV filling pressures”, most of which are not consistently acquired in routine clinical studies
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
