Simultaneous doppler tracing of transmitral inflow and mitral annular velocity as an estimate of elevated left ventricular filling pressure in patients with atrial fibrillation

Abstract

Background: The time interval between the onset of early transmitral flow velocity (E) and that of early diastolic mitral annular velocity (e') (T E-e') is a good predictor of elevated left ventricular (LV) filling pressure in patients with sinus rhythm. Although the evaluation of LV filling pressure using E/e' has been challenging in atrial fibrillation (AF), the usefulness of T E-e' is unknown. Methods and Results: E and e' were simultaneously recorded using dual Doppler echocardiography in 45 AF patients (30 men; mean age, 69±9 years). E/e' and T E-e' were calculated and compared with the pulmonary capillary wedge pressure (PCWP), which was measured invasively. E/e' and T E/e' correlated with PCWP (E/e', r=0.57, P<0.001; T E-e', r=0.77, P<0.001). Using receiver operating characteristic analysis, the optimal cut-off for T E-e' was 34ms (sensitivity, 95%; specificity, 88%) and that for E/e' was 14.6 (sensitivity, 50%; specificity, 84%) in order to predict >12-mmHg PCWP. When the combined cut-offs of T E-e' >34ms and E/e' >14.6 were used, the sensitivity and specificity of predicting elevated PCWP were improved to 100% and 88%, respectively. Conclusions: In AF patients, the simultaneous recording of E and e' using dual Doppler echocardiography and the analysis of T E-e', in addition to E/e', improved the accuracy of evaluation of LV filling pressure.