Will simultaneous measurement of E/e' index facilitate the non-invasive assessment of left ventricular filling pressure in patients with non-valvular atrial fibrillation?

Abstract

Aims: The ratio of early transmitral flow velocity (E) to early diastolic mitral annular velocity (e') was applied as a non-invasive index to assess left ventricular filling pressure (LVFP). However, the reliability of E/e' was undermined in patients with atrial fibrillation (AF). Recently, a novel method entitled 'dual Doppler' was established, which allows simultaneous recording and display of E and e'. Our study investigates whether the dual-Doppler method improves the reliability of E/e' in AF patients. Methods and Results: Forty-nine patients with non-valvular AF underwent conventional echocardiography, dual-Doppler echocardiography, and cardiac catheterization within 4 h. Of 22 patients (45c) with increased LVFP (>15 mmHg), higher E/e' measured by both conventional tissue Doppler imaging (TDI) and dual-Doppler method was observed. Conventional echocardiographic variables were correlated with LVFP (E/e'sep, r = 0.404, E/e'lat, r = 0.487), but E/e' measured synchronously in the dual-Doppler mode yielded a better correlation (E/e'synchronous sep, r = 0.754, E/e'synchronous lat, r = 0.765). The intra- and interobserver variability of the dual-Doppler method was significantly lower than the conventional TDI method. Conclusion: Good correlations were found between E/e'' and LVFP in patients with AF, particularly in the dual-Doppler mode. E/e' measured by the dual-Doppler method can therefore be applied to assess diastolic dysfunction in AF patients.Registry number: ChiCTR-DT-00000342. © The Author 2009.