Optimal Noninvasive Assessment of Diastolic Heart Failure in Patients with Atrial Fibrillation: Comparison of Tissue Doppler Echocardiography, Left Atrium.

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Date of download: 6/25/2016 Copyright © 2016 American Medical Association. All rights reserved. From: BNP-Guided vs Symptom-Guided Heart Failure Therapy:

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Optimal Noninvasive Assessment of Diastolic Heart Failure in Patients with Atrial Fibrillation: Comparison of Tissue Doppler Echocardiography, Left Atrium Size, and Brain Natriuretic Peptide Tomoyuki Watanabe, MD, Masumi Iwai-Takano, MD, Masayoshi Oikawa, MD, Takayoshi Yamaki, MD, Hiroyuki Yaoita, MD, Yukio Maruyama, MD Journal of the American Society of Echocardiography Volume 21, Issue 6, Pages 689-696 (June 2008) DOI: 10.1016/j.echo.2007.08.014 Copyright © 2008 American Society of Echocardiography Terms and Conditions

Figure 1 Measurements of left atrial (LA) area, early transmitral flow velocity (E), and mitral annular velocity (E'). (A), Measurement of LA area in apical 4-chamber view (cm2). (B), Sampling volume is set on tip of mitral leaflets for measurement of E. (C), Sampling volume is set on septal corner of mitral annulus using Doppler tissue imaging for measurement of E'. (D), Peak transmitral flow velocity is calculated as E (cm/s). (E), Peak mitral annular velocity is calculated as E' (cm/s). Journal of the American Society of Echocardiography 2008 21, 689-696DOI: (10.1016/j.echo.2007.08.014) Copyright © 2008 American Society of Echocardiography Terms and Conditions

Figure 2 Early transmitral flow velocity (E)/mitral annular velocity (E') in heart failure (HF) and non-HF groups. E/E' is higher in HF group than in non-HF group. E/E' is increased with progression of New York Heart Association (NYHA) functional class in HF group. Boxes represent 25th, 50th, and 75th percentiles, and whiskers indicate 10th and 90th percentiles. Journal of the American Society of Echocardiography 2008 21, 689-696DOI: (10.1016/j.echo.2007.08.014) Copyright © 2008 American Society of Echocardiography Terms and Conditions

Figure 3 Relationship between early transmitral flow velocity (E)/mitral annular velocity (E') and left atrial area (LAA). E/E' shows significant correlation with LAA in all patients. Solid circles, Patients with heart failure (HF) (HF group); gray circles, patients without heart failure (non-HF group). Journal of the American Society of Echocardiography 2008 21, 689-696DOI: (10.1016/j.echo.2007.08.014) Copyright © 2008 American Society of Echocardiography Terms and Conditions

Figure 4 Diagnostic use for estimating diastolic heart failure (HF) in patients with atrial fibrillation. Receiver operating characteristic curves for early transmitral flow velocity (E)/mitral annular velocity (E'), brain natriuretic peptide (BNP), and left atrial area (LAA) in predicting diastolic HF (New York Heart Association [NYHA] functional class I-IV) (A) and symptomatic diastolic HF (NYHA functional class II-IV) (B). Area under the curve (AUC) for NYHA functional class II to IV was greater than that for NYHA functional class I to IV (0.96 vs 0.89). CI, Confidence interval. Journal of the American Society of Echocardiography 2008 21, 689-696DOI: (10.1016/j.echo.2007.08.014) Copyright © 2008 American Society of Echocardiography Terms and Conditions

Figure 5 Optimal cut-off values for detecting symptomatic diastolic heart failure (HF). Optimal cut-offs are: early transmitral flow velocity (E)/mitral annular velocity (E') greater than 11.7 (sensitivity 87%, specificity 93%, efficiency 91%) (A), brain natriuretic peptide (BNP) greater than 251 pg/mL (sensitivity 70%, specificity 88%, efficiency 82%) (B), and left atrial area (LAA) greater than 25.9 cm2 (sensitivity 48%, specificity 84%, efficiency 72%) (C). NYHA, New York Heart Association. Journal of the American Society of Echocardiography 2008 21, 689-696DOI: (10.1016/j.echo.2007.08.014) Copyright © 2008 American Society of Echocardiography Terms and Conditions

Figure 6 Relationship between changes of early transmitral flow velocity (E)/mitral annular velocity (E') and left atrial area (LAA), and between changes of E and LAA in follow-up study. All follow-up patients exhibited significant correlation between changes of E/E' and LAA (A), but not between changes of E and LAA (B). Solid circles, Improved group; gray circles, unchanged group; NS, not significant. Journal of the American Society of Echocardiography 2008 21, 689-696DOI: (10.1016/j.echo.2007.08.014) Copyright © 2008 American Society of Echocardiography Terms and Conditions