University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK.
Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia.
Europace. 2017 Sep 1;19(9):1427-1438. doi: 10.1093/europace/eux027.
Echocardiography is vital in the routine assessment and management of atrial fibrillation (AF). We performed a systematic review of the validity and reproducibility of echocardiographic left ventricular systolic and diastolic function in AF, and optimal acquisition methods.
Online databases were searched for studies in patients with AF at the time of echocardiography (1960 to August 2015), prospectively registered with PROSPERO (CRD42015025297). The systematic review included 32 studies from 3 066 search results (1 968 patients with AF). Average age was 67 years, 33% were women, mean LVEF 53% (±10%), and average E/e' 11.7 (±2.7). Data on the validity and reproducibility of systolic indices were extremely limited. In contrast, diastolic parameters demonstrated correlation with invasive filling pressure and adequate reproducibility: E/e' (n = 444) r = 0.47 to 0.79; IVRT (n = 177) r = -0.70 to -0.95; E/Vp` (n = 55) r = 0.63 and 0.65; pulmonary vein diastolic flow (n = 67) r = -0.80 and -0.91. Elevated E/e' (>15) was associated with functional capacity, quality of life, and impaired prognosis. For optimal acquisition in AF patients, cardiac cycles with controlled heart rate (<100 beats/min) and similar preceding and pre-preceding RR intervals are required. Cardiac cycle length and equivalence were more important than the number of beats averaged.
With careful selection of appropriate cardiac cycles, echocardiography is a valid tool to identify diastolic dysfunction in AF, and E/e' is an independent marker of clinical status and adverse prognosis. However, data on systolic function was extremely limited and requires further prospective study and assessment of variability in clinical practice.
超声心动图在心房颤动（房颤）的常规评估和管理中至关重要。我们对房颤时超声心动图左心室收缩和舒张功能的有效性和可重复性进行了系统评价，并对最佳采集方法进行了研究。
在线数据库检索了 1960 年至 2015 年 8 月超声心动图时患有房颤的患者的研究（3066 项检索结果中有 1968 例房颤患者），前瞻性地在 PROSPERO（CRD42015025297）注册。系统评价包括 32 项研究，共涉及 3066 项检索结果（1968 例房颤患者）。平均年龄为 67 岁，33%为女性，平均 LVEF 为 53%（±10%），平均 E/e'为 11.7（±2.7）。关于收缩指数的有效性和可重复性的数据极为有限。相比之下，舒张参数与有创充盈压具有相关性且具有足够的可重复性：E/e'（n=444）r=0.47 至 0.79；IVRT（n=177）r=-0.70 至-0.95；E/Vp`（n=55）r=0.63 和 0.65；肺静脉舒张血流（n=67）r=-0.80 和-0.91。E/e'升高（>15）与功能能力、生活质量和预后不良相关。在房颤患者中进行最佳采集时，需要控制心率（<100 次/分钟）且前后 RR 间期相似的心脏周期。心脏周期长度和等效性比平均心跳数更为重要。
通过仔细选择适当的心脏周期，超声心动图是识别房颤患者舒张功能障碍的有效工具，E/e'是临床状态和不良预后的独立标志物。然而，关于收缩功能的数据极为有限，需要进一步进行前瞻性研究和评估临床实践中的变异性。
