PMID- 17904810
OWN - NLM
STAT- MEDLINE
DCOM- 20080925
LR  - 20161124
IS  - 1097-6795 (Electronic)
IS  - 0894-7317 (Linking)
VI  - 21
IP  - 6
DP  - 2008 Jun
TI  - Optimal noninvasive assessment of diastolic heart failure in patients with atrial 
      fibrillation: comparison of tissue doppler echocardiography, left atrium size, 
      and brain natriuretic peptide.
PG  - 689-96
AB  - OBJECTIVE: The aim of this study was to evaluate whether the ratio of early 
      diastolic transmitral velocity to early diastolic mitral annular velocity (E/E') 
      can be applied to identify diastolic heart failure (HF) noninvasively rather than 
      using brain natriuretic peptide (BNP) or enlargement of left atrium (LA) in 
      patients with atrial fibrillation (AF) by comparing the severity of HF symptoms. 
      Moreover, we investigated the relationship between the changes in E/E' and the 
      severity of HF or LA remodeling in the follow-up period. METHODS: We examined 73 
      patients with nonvalvular AF disease and preserved left ventricular ejection 
      fraction (>50%), ie, patients with diastolic HF accompanied with New York Heart 
      Association (NYHA) functional class I to IV (n = 32, HF group) and those without 
      HF (n = 41, non-HF group). No patients showed dyspnea caused by anemia, renal 
      failure, lung disease, or other disease states except HF. We evaluated E, E', and 
      E/E' by Doppler echocardiography, and the LA area (LAA) by 2-dimensional 
      echocardiography. BNP levels were also examined. A follow-up study was performed 
      in 18 of the 32 patients with HF. RESULTS: E/E', LAA, and BNP were higher in the 
      HF group than in the non-HF group (E/E', 15 +/- 5 vs 9 +/- 2; LAA, 24 +/- 6 vs 20 
      +/- 6 cm(2); and BNP, 321 +/- 200 vs 140 +/- 76 pg/mL, each P < .01). Using the 
      receiver operating characteristic curve for identification of symptomatic 
      diastolic HF with NYHA functional class II to IV, the areas under the curves 
      were: E/E', 0.96 (95% confidence interval 0.91-1.0); LAA, 0.77 (95% confidence 
      interval 0.64-0.89); and BNP, 0.85 (95% confidence interval 0.75-0.95). In the HF 
      group, 18 patients who were re-examined 17 +/- 9 weeks after were divided into 
      two groups, depending on the improvement in NYHA functional class, ie, improved 
      group (n = 10) and unchanged group (n = 8). In the follow-up period, E (112 +/- 
      20-94 +/- 21 cm/s), E/E' (17.1 +/- 5-13.1 +/- 3), and LAA (28 +/- 5-24 +/- 4) 
      decreased in the improved group (each P < .05), but E' and BNP did not. 
      CONCLUSIONS: E/E' could be useful in identifying symptomatic diastolic HF and 
      evaluating the functional state in the process of HF in patients with AF. 
      Moreover, E/E' is able to assess the improvement of diastolic HF in AF.
FAU - Watanabe, Tomoyuki
AU  - Watanabe T
AD  - Division of Cardiology and Internal Medicine, Health Co-op Watari Hospital, 
      Fukushima, Japan.
FAU - Iwai-Takano, Masumi
AU  - Iwai-Takano M
FAU - Oikawa, Masayoshi
AU  - Oikawa M
FAU - Yamaki, Takayoshi
AU  - Yamaki T
FAU - Yaoita, Hiroyuki
AU  - Yaoita H
FAU - Maruyama, Yukio
AU  - Maruyama Y
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20070929
PL  - United States
TA  - J Am Soc Echocardiogr
JT  - Journal of the American Society of Echocardiography : official publication of the 
      American Society of Echocardiography
JID - 8801388
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Atrial Fibrillation/blood/diagnosis/*diagnostic imaging/*physiopathology
MH  - Diastole
MH  - *Echocardiography, Doppler
MH  - Female
MH  - Heart Atria/*diagnostic imaging/pathology/physiopathology
MH  - Heart Failure/blood/diagnosis/*diagnostic imaging/*physiopathology
MH  - Humans
MH  - Male
MH  - Natriuretic Peptide, Brain/*blood
MH  - Prospective Studies
MH  - Severity of Illness Index
MH  - Stroke Volume
EDAT- 2007/10/02 09:00
MHDA- 2008/09/26 09:00
CRDT- 2007/10/02 09:00
PHST- 2007/04/18 00:00 [received]
PHST- 2007/10/02 09:00 [pubmed]
PHST- 2008/09/26 09:00 [medline]
PHST- 2007/10/02 09:00 [entrez]
AID - S0894-7317(07)00605-0 [pii]
AID - 10.1016/j.echo.2007.08.014 [doi]
PST - ppublish
SO  - J Am Soc Echocardiogr. 2008 Jun;21(6):689-96. doi: 10.1016/j.echo.2007.08.014. 
      Epub 2007 Sep 29.