Relationship between Echocardiographic Diastolic Indices and Invasively Measured Left Ventricular End-Diastolic Pressure in Chronic Atrial Fibrillation Patients with Preserved Left Ventricular Ejection Fraction

Objective: Left ventricular (LV) filling pressure can be estimated using echocardiographic measurements, including the ratio of transmitral early peak flow velocity to tissue Doppler mitral annular motion velocity (E/e') during sinus rhythm. However, non-invasive echocardiographic estimation is complicated in patients with atrial fibrillation (AF). AF is associated with reduced survival in patients with heart failure with preserved LV ejection fraction (LVEF). The aim of this study was to investigate echocardiographic parameters for predicting LV filling pressure and diastolic function in chronic AF patients with preserved LVEF. Methods: Clinical data, echocardiographic findings, and laboratory data were assessed retrospectively in 90 chronic AF patients with preserved LVEF who underwent diagnostic left-heart catheterization between January 2011 and September 2015. LV end-diastolic pressure (LVEDP) assessment and standard echocardiographic measurements were performed. Results: The E/e' ratio was significantly correlated with LVEDP (r= 0.449, P< 0.001). Receiver operating characteristic analysis defined the optimal cut-off for E/e' as 13 (sensitivity, 88%; specificity, 67%) to predict elevated LVEDP (> 15 mm Hg). E (r= 0.463, P< 0.001) and E/propagation velocity (Vp; r= 0.471, P< 0.001) were also correlated with LVEDP. E > 90 cm/sec predicted elevated LVEDP with a sensitivity of 84% and a specificity of 70%. Also, an E/Vp >1.6 predicted elevated LVEDP with a sensitivity of 80% and a specificity of 72%. Conclusion: E >90 cm/sec, E/e' >13 and E/Vp >1.6 were suggestive of elevated LVEDP in these patients. Therefore, E, E/e' , and E/Vp provide significant predictive value for LVEDP in chronic AF with preserved LVEF.