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Background: As reinforced by the 2016 American Society of Echocardiography (ASE) diastology guidelines, early mitral inflow velocity (E) to medial mitral early diastolic tissue Doppler velocity (e') ratio is a key component in the noninvasive assessment of left-sided filling pressures. However, the performance of E/e’ in atrial fibrillation or atrial flutter is largely unknown.
Methods: Mitral inflow pulse-wave and medial mitral valve tissue Doppler data were obtained in 23 patients with elevated pulmonary artery wedge (PAWP) or left atrial (LA) pressure undergoing invasive hemodynamic assessment. Elevated left filling pressures were defined as mean PAWP or direct LA pressure ≥15 mmHg.
Results: Twelve patients were in sinus rhythm and 11 had atrial fibrillation/flutter. Clinical, hemodynamic, and echocardiographic data are presented below.
Conclusions: When compared to sinus rhythm, E/e’ > 15 performed poorly as an indicator of high filling pressures in atrial fibrillation/flutter and not should be used in such patients. However, >80% of patients with atrial fibrillation/flutter had an E/e'> 11, an alternative cut-off suggested by the guidelines. Further studies focused on noninvasive assessment of left-sided filling pressure are needed given the high prevalence of atrial fibrillation/flutter.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Innovative Use of Echocardiography
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1197-224
- 2017 American College of Cardiology Foundation