Is the ratio of transmitral peak E-wave velocity to color flow propagation velocity useful for evaluating the severity of heart failure in atrial fibrillation?

Abstract

Background: Although analysis of the transmitral inflow (TMF) pattern is widely used for evaluating left ventricular diastolic function and provides valuable information for the management of heart failure (HF) in sinus rhythm, its utility in patients with atrial fibrillation (AF) has not been established. The aim of this study was to investigate the relationship between the ratio of transmitral peak E-wave velocity to flow propagation velocity (E/Vp) obtained by a newly developed dual Doppler system and the plasma B-type natriuretic peptide (BNP) concentration or pulmonary capillary wedge pressure (PCWP) for evaluating the severity of heart failure with AF. Methods and Results: In 68 patients with AF, the E/Vp was compared with plasma BNP concentration and PCWP. A cutoff value of ≥1.7 for E/Vp predicted a plasma BNP concentrationl of ≥200pg/ml, with 80% sensitivity and 84% specificity. Only E/Vp was found to be independently significant by stepwise multilinear regression analysis (r=0.40, p=0.01). PCWP values had good correlation with E/Vp (r=0.63, p<0.01) and were significantly higher in the group with E/Vp ≥1.7 (16±6mmHg vs 11±4 mmHg, p<0.05). Conclusion: The Doppler-derived index of E/Vp correlated well with the neurohormonal and hemodynamic parameters, and was useful for evaluating the severity of heart failure with AF.