TY - JOUR
T1 - The challenge of chamber stiffness determination in chronic atrial fibrillation VS. Normal sinus rhythm
T2 - Echocardiographic prediction with simultaneous hemodynamic validation
AU - Mossahebi, Sina
AU - Shmuylovich, Leonid
AU - Kovács, Sándor J.
PY - 2013/10/1
Y1 - 2013/10/1
N2 - Echocardiographic diastolic function (DF) assessment remains a challenge in atrial fibrillation (AF), because indexes such as E/A cannot be used and because chronic, rate controlled AF causes chamber remodeling. To determine if echocardiography can accurately characterize diastolic chamber properties we compared 15 chronic AF subjects to 15, age matched normal sinus rhythm (NSR) subjects using simultaneous echocardiography-cardiac catheterization (391 beats analyzed). Conventional DF parameters (DT, Epeak, AT, Edur, E-VTI, E/E') and validated, E-wave derived, kinematic modeling based chamber stiffness parameter (k), were compared. For validation, chamber stiffness (dP/dV) was independently determined from simultaneous, multi-beat P-V loop data. Results show that neither AT, Epeak nor E-VTI differentiated between groups. Although DT, Edur and E/E' did differentiate between groups (DTNSR vs. DTAF p < 0.001, EdurNSR vs. EdurAF p < 0.001, E/E'NSR vs. E/E'AF p < 0.05), the model derived chamber stiffness parameter k was the only parameter specific for chamber stiffness, (kNSR vs. kAF p < 0.005). The invasive gold standard determined end-diastolic stiffness in NSR was indistinguishable from end-diastolic (i.e. diastatic) stiffness in AF (p = 0.84). Importantly, the analysis provided mechanistic insight by showing that diastatic stiffness in AF was significantly greater than diastatic stiffness in NSR (p < 0.05). We conclude that passive (diastatic) chamber stiffness is increased in normal LVEF chronic, rate controlled AF hearts relative to normal LVEF NSR controls and that in addition to DT, the E-wave derived, chamber stiffness specific index k, differentiates between AF vs. NSR groups, even when invasively determined end-diastolic chamber stiffness fails to do so.
AB - Echocardiographic diastolic function (DF) assessment remains a challenge in atrial fibrillation (AF), because indexes such as E/A cannot be used and because chronic, rate controlled AF causes chamber remodeling. To determine if echocardiography can accurately characterize diastolic chamber properties we compared 15 chronic AF subjects to 15, age matched normal sinus rhythm (NSR) subjects using simultaneous echocardiography-cardiac catheterization (391 beats analyzed). Conventional DF parameters (DT, Epeak, AT, Edur, E-VTI, E/E') and validated, E-wave derived, kinematic modeling based chamber stiffness parameter (k), were compared. For validation, chamber stiffness (dP/dV) was independently determined from simultaneous, multi-beat P-V loop data. Results show that neither AT, Epeak nor E-VTI differentiated between groups. Although DT, Edur and E/E' did differentiate between groups (DTNSR vs. DTAF p < 0.001, EdurNSR vs. EdurAF p < 0.001, E/E'NSR vs. E/E'AF p < 0.05), the model derived chamber stiffness parameter k was the only parameter specific for chamber stiffness, (kNSR vs. kAF p < 0.005). The invasive gold standard determined end-diastolic stiffness in NSR was indistinguishable from end-diastolic (i.e. diastatic) stiffness in AF (p = 0.84). Importantly, the analysis provided mechanistic insight by showing that diastatic stiffness in AF was significantly greater than diastatic stiffness in NSR (p < 0.05). We conclude that passive (diastatic) chamber stiffness is increased in normal LVEF chronic, rate controlled AF hearts relative to normal LVEF NSR controls and that in addition to DT, the E-wave derived, chamber stiffness specific index k, differentiates between AF vs. NSR groups, even when invasively determined end-diastolic chamber stiffness fails to do so.
KW - Atrial fibrillation
KW - Diastasis
KW - Diastolic function
KW - Echocardiography
KW - Pdf formalism
UR - http://www.scopus.com/inward/record.url?scp=84892844650&partnerID=8YFLogxK
M3 - Article
AN - SCOPUS:84892844650
VL - 6
SP - 45
EP - 50
JO - Journal of Atrial Fibrillation
JF - Journal of Atrial Fibrillation
SN - 1941-6911
IS - 3
ER -