Comparison of Mitral Doppler Flow, Flow Propagation Velocity and Peak Filling Rate between Patients with Normal and Systolic LV Dysfunction in Presence of Atrial Fibrillation

BACKGROUND: Methods for evaluating left ventricular diastolic function have been used exclusively in cardiac patients in sinus rhythm and have not been applied to atrial fibrillation because of large cycle variation in flow velocities and absence of atrial contraction. The utility of these rnethods in atrial fibrillation is unknown, especially M-rnode Doppler echocardiography and automatic border detection method. METHODS: Left Ventricular Normal group(LVN group, Ejection fraction> 40%) of 21 patients(mean age 67 years old, 12 men, 9 women) and Left Ventricular Dysfunction group (LVD group, EF ( 40%) of 15 patients(mean age 64 years old, 11 men, 4 women) were studied. We measured parameters in pulsed Doppler recordings of rnitral flow velocity and the flow propagation velocity in color M-mode recording of mitral flow, and peak filling rate from automatic border detection system. Measurements were averaged over 10 cardiac cycles. RESULTS: Mean heart rates were not different in both population(LVN 79+/-18/min, LVD 83+/-16/min). Left ventricular diastolic dimension were more dilated LVD group than LVN group(5.7+/-1.0crn, 4.6+/-0.7cm p < 0.05) but left atrial dimension were similar(4.4+/-0.8cm, 4.3+/-0.7cm). Deceleration time was significantly shortened in LVD group(158.4+/-24.4ms vs. 180.4+37.6ms, p < 0.05) but other parameters of mitral pulsed Doppler recording such as IVRT, acceleration time, acceleration rate and deceleration rate were not different. Flow propagation velocities were significantly decreased in LVD group(41.7+/-14.9cm/s vs. 53.0+/-11. 9cm/s, p < 0.05). Peak filling rates of automatic border detection system were significantly decreased in LVD group(3.4+/-1.2 EDV/s vs 5.4+/-1.1 EDV/s, p< 0.001). CONCLUSION: Echocardiographic measurements of diastolic function via color M-mode Doppler and autornatic border detection may be useful in presence of atrial fibrillation as sinvs rhythm.

On-Line Assessment of Left Ventricular Cavity Area and Function by Automatic Border Detection Echocardiography

BACKGROUND: Assessment of left ventricular function with conventional 2-dimensional echocardiography (2D echo) remains largely qualitative and subjective because the manual tracing of endocardial borders is laborious and tedious. An automatic border detection (ABD) echo has been recently developed that permits real-time measurements of chamber areas and cardiac function. METHODS: To determine usefulness of ABD echo, left ventricular cross-sectional areas were automatically measured from the parasternal short-axis image in 25 cases including 9 cardiac patients, and compared with those by off-line analysis of the conventional 2D echo image. RESULTS: In on-line ABD analysis, short axis end-diastolic area averaged 13.1+/-2.2cm2, end-systolic area 5.3+/-1.3cm2 and fractional area change 59.4+/-9.0% and off-line manual analysis yielded corresponding values of 14.7+/-2.5cm2, 6.2+/-1.3cm2, and 57.1+/-7.1%. The end-diastolic and end-systolic areas by both methods were significantly different, respectively. Left ventricular end-diastolic and end-systolic area and fractional area change obtained from ABD echo correlated significantly with those of off-line measurements(r=0.897, p<0.001 ; r=0.505, p<0.01 ; r=0.427, p<0.05). CONCLUSION: Thus, these facts suggest that ABD echo is useful for on-line continuous measurement of chamber areas and cardiac function.