Key result
Two-step echo and BMI algorithm effectively differentiates normal from elevated LVFP in AF.
Why the study?
Echocardiographic assessment of LV diastolic function in patients with AF is challenging due to cycle length variability, lack of atrial contraction, and left atrial enlargement, meaning standard 2016 recommendation algorithms cannot be directly applied.
This review highlights the challenges of diagnosing diastolic dysfunction and HFpEF in patients with atrial fibrillation and discusses a proposed diagnostic algorithm to determine elevated left ventricular filling pressures.
May support diastolic evaluation in AF where 2016 criteria falter; leaves open prospective validation before clinical use.
Left ventricular (LV) diastolic dysfunction, atrial fibrillation (AF), and heart failure with preserved ejection fraction (HFpEF) share common risk factors and are closely related to one another and to adverse cardiovascular events. Exertional dyspnoea in patients with AF should trigger a comprehensive LV diastolic function evaluation since AF frequently precedes incident HFpEF. An echocardiographic assessment of LV diastolic function in patients with AF is challenging, mainly because of variability in cycle length, the absence of atrial contraction, and the frequent occurrence of left atrial enlargement regardless of LV filling pressures (LVFPs). The algorithm of the 2016 recommendations for the evaluation of LV diastolic function cannot be directly applied in this setting. This review discusses the modalities available for diastolic function assessment and HFpEF diagnosis in patients with AF. Based on currently available data, a reasonable clinical target of diastolic function evaluation in AF would be to reach a binary conclusion: LVFP elevated or not. Recently, a two-step algorithm that combined several echocardiographic parameters plus the inclusion of body mass index has been proposed to differentiate normal from elevated LVFP in patients with AF. The echocardiographic evaluation must be complemented by a thorough clinical evaluation along with natriuretic peptides and cardiac catheterization in selected cases. If a diagnosis of HFpEF cannot be ascertained, a close follow-up for timely identification of diastolic dysfunction markers, along with monitoring and correction of modifiable risk factors, is recommended.
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Beladan et al. (2024) studied this question. A two-step algorithm combining echocardiographic parameters and body mass index effectively differentiates normal from elevated left ventricular filling pressures in patients with atrial fibrillation.
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