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Marker of diastolic function correlates with pulmonary capillary wedge pressure in setting of atrial fibrillation
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The ratio of early diastolic transmitral flow velocity to early diastolic mitral annular velocity correlated with two key biomarkers in patients with atrial fibrillation.
Researchers enrolled 56 patients with AF and preserved systolic function. All patients underwent routine echocardiography. The study objective was to evaluate the usefulness as an index of the ratio of early diastolic transmitral flow velocity (E) to the mitral annular velocity (e´), which was calculated from simultaneously recorded early diastolic transmitral flow velocity and mitral annular velocity in AF.
The researchers reported a positive linear relationship between the mean lateral E/e´ ratio (P<.001), as well as the mean septal E/e´ ratio (P<.001). Mean lateral mitral annular velocity was higher than septal mitral annular velocity (P<.05), and the mean lateral E/e´ was lower than the mean septal E/e´ (P<.05). A positive relationship between the mean later E/e´ and the single-beat lateral E/e´ ratio was reported (P<.001). The single-beat lateral E/e´ ratio correlated with pulmonary capillary wedge pressure (P<.001), as did the conventional lateral E/e´ ratio (P<.01). A single-beat E/e´ ratio of at least 11 could predict elevated pulmonary capillary wedge pressure (≥15 mm Hg) with both a specificity of 90% and a sensitivity of 90%. The researchers also reported a positive linear relationship between brain natriuretic peptide (BNP) and mean lateral E/e´ ratio (P<.001).
“The results of this study showed that the plasma BNP level and pulmonary capillary wedge pressure could be estimated based on the single-beat lateral E/e´, even in AF patients with preserved systolic function,” the researchers wrote. “Therefore, this parameter may facilitate the evaluation of left ventricular diastolic function in the presence of AF, which is difficult to assess by conventional Doppler echocardiography, suggesting its clinical usefulness. Our simultaneous E/e´ should be useful for evaluating response to the treatment of AF patients with HF and predicting their prognosis.”
In an accompanying editorial by Cleveland Clinic cardiologists Zoran B. Popovic, MD, PhD, and Allan L. Klein, MD, they praised the investigators for applying new dual Doppler echocardiography technology to an old clinical problem.
“The investigators show that if the E/e´ ratio is measured during a cardiac cycle in which the ratio of preceding and pre-preceding beats approaches one, it closely correlates with the E/e´ ratio measured by the standard method of averaging E and e´ measured from multiple nonsimultaneously acquired beats,” they wrote. “However, more clinically important is that they also show a very good correlation with the BNP level, a well-known marker of survival. By showing this key fact, this report confirms the clinical relevance of the E/e´ ratio in difficult patients in whom diastolic function must be assessed.”
Kusunose K. J Am Coll Cardiol Img. 2009;2:1147-1156.