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Objective To discuss the value of E/e′index measured by dual gate Dopper predicting recurrence after radio frequency catheter ablation ( RFCA ) in persistant atrial fibrillation ( PeAF) patients . Methods Fifty‐three patients with PeAF w ho had successful RFCA and 25 controls were prospectively enrolled . T he patients with PeAF were divided into AF recurrence group ( n ＝21) and AF non‐recurrence group ( n ＝32) with median follow‐up time of ( 25 .94 ± 2 .78) months . All patients with PeAF underwent echocardiography in the preoperative 7 days . With dual gate Doppler ,transmitral flow peak velocity ( E) and mitral annular septal or lateral peak velocity e′( S ) , and e′( L ) in early diastolic were measured simultaneously in the same cardiac cycle ,then E/e′( S ) and E/e′( L ) were automatically calculated .With traditional method ,E ,e′( S) and e′( L ) were measured in different cardiac cycles ,then E/e′( S) and E/e′( L ) were manually calculated .T he time of w hole analysis process with each method was recorded . Results PeAF patients had bigger E/e′( S ) and E/e′( L ) with both dual gate Doppler and traditional method than controls . Compared with those in controls and AF non‐recurrence group ,E/e′( S) and E/e′( L ) increased in AF recurrence group with both dual gate Doppler and traditional method ( all P ＜ 0 .05 ) . No statistical difference was found between the data acquired by dual gate Doppler and traditional method ( all P ＞0 .05) . Cut‐off values of 10 .90 ( sensitivity of 71 .4% ,specificity of 87 .5% ) for E/e′( S) was obtained by dual gate Doppler and 10 .70 ( sensitivity of 81 .0% ,specificity of 62 .5% ) was obtained by traditional method for predicted AF recurrence . Areas under curves between the two methods in ROC analysis was not significant ( 0 .819 vs 0 .728 , P ＞0 .05) . T he w hole analysis time of dual gate Doppler was less than that of traditional method . Between inter‐and intraobservers ,the interclass correlation coefficient with dual gate Doppler was higher and 95% confidence interval range was smaller . Conclusions E/e′( S ) is a valuable predictor for PeAF recurrence after RFCA in patients with PeAF . Dual gate Doppler can noninvasively assess single‐beat E/e′with less analysis time and better reproducibility compared with traditional method .
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Objective To evaluate the changes of intra-and interatrial synchronization with age in normal adults by dual gate Doppler and discuss the feasibility of dual gate Doppler in assessing atrial synchronization.Methods Fifty-seven healthy volunteers were divided into three groups according to age:group A (20-39 years old,n =20),groupB(40-59 years old,n =21),groupC (60-79 years old,n =16).The time interval of the onset of a'wave between mitral annular septal and lateral site was T1 by dual gate Doppler,which was used to evaluate left atrial synchronization.The time intervals from the onset of a'wave at tricuspid annular right ventricular free wall site to a'wave at tricuspid annular septal site and mitral annular lateral site were T2 and T3,which were respectively used to evaluate right atrial and interatrial synchronization.With traditional Doppler technique,the time intervals from the onset of P wave to the onset of a'wave at the mitral annular lateral site (P-L),the mitral annular septal site (P-S),and the tricuspid annular right ventricular free wall site (P-RVFW) were measured.The time differences between P-L and P-S,between P-S and P-RVFW,and between P-L and P-RVFW were t1 (left atrial synchronization),t2 (right atrial synchronization),t3 (interatrial synchronization).The greater time interval predicted the worse synchronization.Results ① Systolic and diastolic blood pressure elevated with age among three groups (P＜0.05).Compared with group A,the ratio (E/e') of early diastolic transmitral flow velocity (E) and mitral annular velocity of septal site (e'),and late diastolic transmitral flow velocity increased in group B and C.In contrast with group A and B,left atrial volume (LAV) increased,and E decreased in group C (all P ＜0.05).②Compared with group A,T1,T2,T3 and t1,t2,t3 increased in group B and C (all P ＜0.05).③T1,T2 and T3 were positively correlated with age,body mass index,systolic blood pressure,left atrial systolic antero-posterior diameter and E/e'(all P ＜0.05).Besides,T1 was positively correlated with LAV (P ＜0.05).T3 was positively correlated with LAV and right atrial upper-inferior diameter.④ The parameters of atrial synchronization in dual gate Doppler were concordant with that in traditional Doppler technique.And the measurements of two methods were correlated (r =0.78,P ＜0.01).For inter-and intraobservers,the interclass correlation coefficient with dual gate Doppler was higher and 95 ％ confidence interval range was smaller.Conclusions The intra-and interatrial synchronization reduces with age in normal adults.Dual gate Doppler is feasible in evaluating atrial synchronization,which can provide more repeatable measurements and can be a new prospective method to assess atrial synchronization.
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Objective To discuss whether atrial synchronization measured by dual gate Dopper can predict recurrence after radiofrequency catheter ablation ( RFCA) in paroxysmal atrial fibrillation ( PAF) patients . Methods Forty-five patients with PAF who had successful RFCA and 26 controls with sinus rate were prospectively enrolled . During 6-month follow-up , the patients with PAF were divided into AF recurrence group ( n = 16) and AF non-recurrence group ( n = 29) . All patients with PAF underwent echocardiography in the preoperative 7 days . The time interval of the onset of the late diastolic ( a′) wave between mitral annular septal and lateral site was T 1 by dual gate Doppler ,which was used to evaluate left atrial synchronization . The time intervals from the onset of a′ wave at tricuspid annulus right ventricular free wall site to a′wave at tricuspid annular septal site and mitral annular lateral site were T 2 and T3 ,which were respectively used to evaluate right atrial and interatrial synchronization . The greater time interval predicted the worse synchronization . Results Compared with controls ,left atrial diameter ,volume and volume index ,right atrial transverse diameter ,volume and volume index ,T 1 ,T2 and T3 ( standardized before and after) increased in patients with PAF ( all P <0 .05) . In patients with PAF ,left atrial volume index and T2 ( standardized before and after) had no differences between AF recurrence group and AF non-recurrence group( P >0 .05) . But there was a trend toward lager left atrial diameter in the AF recurrence group ( P < 0 .05) . T1 and T3 ( standardized before and after) increased significantly in AF recurrence group (all P < 0 .05) . Multivariate logistic regression analysis indicated standardized T 1 was the only independent predicator of AF recurrence after RFCA ( OR = 1 .060 ,95％ CI 1 .002 -1 .121 , P = 0 .044) . The area under curve of standardized T1 for predicting recurrence was 0 .709％ , the sensitivity and specificity were 62 .5％ and 75 .9％ using a cutoff value of standardized T1≥39 .38 ms . Conclusions T1 significantly prolongs in patients with AF recurrence . Dual gate Doppler as a new technique to evaluate atrial synchronization can provide predictive value for 6-month recurrence after RFCA .
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Objective To evaluate intra-and interatrial synchronization in patients with paroxysmal atrial fibrillation (PAF) by dual gate Doppler and discuss the predictive value of atrial asynchrony for detecting PAF.Methods Twenty-nine patients with PAF as AF group and 24 healthy volunteers as control group underwent echocardiography.The time interval of the onset of a'wave between mitral annular septal and lateral site was T1 by dual gate Doppler,which was used to evaluate left atrial synchronization.The time intervals from the onset of a'wave at tricuspid annular right ventricular free wall site to a'wave at tricuspid annular septal site and mitral annular lateral site were T2 and T3,which were respectively used to evaluate right atrial and interatrial synchronization.The greater time interval predicted the worse synchronization.Compared these indexes between two groups,the most valuable index was obtained and combined with left atrial volume index (LAVI) to predict PAF,its optimal values were found out by ROC curve.Results ①There were no significant differences in many other basic indexes between two groups (P ＞0.05).However,compared with control group,the ratio of early diastolic transmitral flow velocity (E) and mitral annular velocity of septal site (e'),the diameters and volume indexes of atria were significantly increased in AF group.②T1,T2 and T3 (standardized before and after) increased significantly in AF group (P ＜0.01).Standardized T1 had the largest area under curve (AUC) for detecting PAF.The AUC of standardized T1 and LAVI were 76.6％ and 84.1％.Standardized T1 ≥29.55 ms and LAVI≥ 21.60 ml/m2 were combined for detecting PAF (sensitivity 82.8 ％,specificity 79.2％,AUC 87.1％).③ Standardized T1 was positively correlated with age,left atrial systolic diameter,LAVI,RAVI and E/e'(P＜ 0.05).Conclusions Patients with PAF have worse intra-and interatrial synchronization and left atrial asynchrony can provide predictive value for detecting PAF.Dual gate Doppler is expected to be a new technique for evaluating intra-and interatrial synchronization accurately and detecting the risk of AF.