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 15 mm Hg). E (r=0.463, P 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.

A Case of Dysphagia Aortica Caused by a Large Thoracic Aortic Aneurysm

Dysphagia aortica is a rare condition defined by difficulty in swallowing and is caused by extrinsic compression of the esophagus due to an ectatic, tortuous, or aneurysmatic atherosclerotic thoracic aorta. It is easy to miss the diagnosis if the clinician does not consider the possibility of dysphagia caused by a thoracic aortic aneurysm. We present the case of an 82-year-old man who developed dysphagia aortica associated with a large thoracic aortic aneurysm. Extrinsic compression of the esophagus caused by an enlarged thoracic aorta was seen on upper gastrointestinal endoscopy, barium esophagogram, and chest computed tomography. With dietary modifications, his symptoms of dysphagia gradually improved.