Assessment of the Left Ventricular Diastolic Function and Its Association with the Left Atrial Pressure in Patients with Atrial Fibrillation.

International Journal of Heart Failure Pub Date : 2020-01-29 eCollection Date: 2020-01-01 DOI:10.36628/ijhf.2020.0003
Mi-Na Kim, Seong-Mi Park, Hee-Dong Kim, Dong-Hyuk Cho, Jaemin Shim, Jong-Il Choi, Young Hoon Kim, Wan Joo Shim
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引用次数: 7

Abstract

Background and Objectives The evaluation of left ventricular (LV) diastolic function in patients with atrial fibrillation (AF) is challenging. This study aimed to investigate the efficacy of the diagnostic algorithm for LV diastolic dysfunction (LVDD) in the current guidelines and to evaluate the association between increased left atrial pressure (LAP) and LV diastolic parameters. Methods One hundred and twenty-four patients with non-valvular AF and a preserved LV ejection fraction who had the same rhythm status on echocardiography and LAP measurements during catheter ablation were included. LV diastolic function was classified as normal, indeterminate, or LVDD according to the recent guidelines. Increased LAP was defined as mean LAP (mLAP) ≥15 mmHg. Results The mLAP was not different among the normal, indeterminate, and LVDD groups. However, the prevalence of increased LAP was higher in the LVDD group. Among the LV diastolic parameters, only medial E/e′ was independently associated with mLAP in the whole study population. In patients with persistent AF (PeAF), E/e′ and e′ were significantly associated with mLAP, whereas in paroxysmal AF (PAF), mLAP was not associated with the LV diastolic parameters but with left atrial conduit function. Conclusions In general, increased LAP is known to be closely related with LVDD. However, the algorithm for LVDD from recent guidelines does not reflect well the increased LAP in AF patients. The diastolic parameters may aid in estimating the increased LAP in PeAF but may only have limited value for assessing increased LAP in PAF.

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评价心房颤动患者左室舒张功能及其与左房压的关系
背景与目的:评价心房颤动(AF)患者左室(LV)舒张功能具有挑战性。本研究旨在探讨现行指南中左室舒张功能障碍(LVDD)诊断算法的有效性,并评估左房压升高(LAP)与左室舒张参数之间的关系。方法:124例非瓣膜性房颤和左室射血分数保持不变的患者,在超声心动图和导管消融期间LAP测量具有相同的节律状态。根据最近的指南,左室舒张功能分为正常、不确定或LVDD。LAP升高定义为平均LAP (mLAP)≥15 mmHg。结果:mLAP在正常组、不确定组和LVDD组间无明显差异。然而,LAP升高的发生率在LVDD组更高。在左室舒张参数中,在整个研究人群中,只有内侧E/ E '与mLAP独立相关。在持续性房颤(PeAF)患者中,E/ E′和E′与mLAP显著相关,而在阵发性房颤(PAF)患者中,mLAP与左室舒张参数无关,但与左房导管功能相关。结论:一般情况下,LAP升高与LVDD密切相关。然而,最新指南中的LVDD算法并不能很好地反映AF患者LAP的增加。舒张参数可能有助于估计PeAF中LAP升高,但对PAF中LAP升高的评估价值有限。
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