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Lee, Lee, Choi, Choi, Lee, Lee, Lee, Kim, Kim, Ko, Kim, and Ryu: Association of New Parameters Derived from Relation between RR intervals and Left Ventricular Performances with Heart Failure in Patients with Atrial Fibrillation and Normal Systolic Function
Original Article
Korean Circulation Journal

Korean Circulation Journal 2007; 37(3): 119-126.

Published online: 31 March 2007

DOI: https://doi.org/10.4070/kcj.2007.37.3.119

Association of New Parameters Derived from Relation between RR intervals and Left Ventricular Performances with Heart Failure in Patients with Atrial Fibrillation and Normal Systolic Function

Kwang Ho Lee, MD, Kyung Heon Lee, MD, Yeo Won Choi, MD, Soo Hee Choi, MD, Kyung Eun Lee, MD, Sung Ho Lee, MD, Kwang Je Lee, MD, Sang Wook Kim, MD, Tae Ho Kim, MD, Hong Sook Ko, PhD, Chee Jeong Kim, MD, Wang Seong Ryu, MD

Division of Cardiology, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.

Corresponding author (cjkim@cau.ac.kr)

Received 4 January 2007       Revised 7 February 2007       Accepted 27 February 2007

© 2007, The Korean Society of Circulation

Abstract

Background and Objectives

Heart failure (HF) may occur in atrial fibrillation (AF) patients with a normal left ventricular (LV) systolic function if the diastolic function is impaired. The association of new parameters from the relationship between the preceding RR interval (RR-1) and LV outflow peak ejection velocity (Vpe) with systolic function has been reported. The aim of this study was to observe whether these parameters were associated with HF in AF patients with a normal systolic function.

Subjects and Methods

AF patients with a normal systolic function were divided into two groups according to the presence (n=16) or absence (n=30) of a history of HF. From the logarithmic equation between RR-1 and Vpe, the slope, Vpe at RR-1 second (Vpe-1), and Slope/Vpe-1 were calculated.

Results

Patients with a history of HF were older (p=0.037) and tended to more frequently have hypertension (p=0.063) than those with no history of HF. The ejection fractions were similar between the two groups. In the coordinates with RR-1 from 0.6 to 1 second, the slope tended to be steeper (p=0.074) and slope/Vpe-1 was higher in patients with a history of HF (p=0.011). The Vpe-1 was similar between the two groups (p=0.66). A multiple forward logistic regression analysis showed that slope/Vpe-1 was the only independent variable associated with the occurrence of HF. Slope/Vpe-1 was related with aortic regurgitation, HF history, and the interventricular septal thickness in a multiple stepwise regression analysis.

Conclusion

New parameters from the relationship between the RR intervals and LV performances were associated with the occurrence of HF in AF patients with a normal systolic function. This finding suggests that these parameters may be related with the LV diastolic function.

Keywords: Atrial fibrillation, Pulsed Doppler echocardiography, Heart failure, congestive, Ventricular function, left, Predictive value of tests

Figures and Tables

Fig. 1
The representative example of the relationship of preceding (RR-1) and prepreceding RR (RR-2) intervals with left ventricular peak ejection velocity (Vpe). A: relation between RR-2 and Vpe. B: relation between RR-2 and Vpe when the coordinates with RR-1≤0.5 second were excluded. C: relation between RR-1 and Vpe. D: relation between RR-1 and Vpe adjusted with the influence of RR-2. E: relation between RR-1 and Vpe when divided into two zones, short RR intervals (>0.6 second) and long RR interval (>0.6 second) (Adopted from reference 16 with modification). LV: left ventricular.
kcj-37-119-g001
Table 1
Comparisons of demographic and clinical characteristics between patients with and without heart failure history
kcj-37-119-i001

IHD: ischemic heart disease

Table 2
Comparisons of echocardiographic findings and new parameters derived from the correlation between RR interval and LV outflow peak ejection velocity between patients with and without heart failure history
kcj-37-119-i002

LVIDd: diastolic dimension of left ventricle, LVIDs: systolic dimension of left ventricle, FS: fractional shortening, EF: ejection fraction, LA: left atrium, IVS: diastolic thickness of interventricular septum, LVPW: diastolic thickness of left ventricular posterior wall, LVM: left ventricular mass, MR: mitral regurgitation, AR: aortic regurgitation, RR-1: preceding RR interval, Vpe: LV outflow peak ejection velocity, Slope/Vpe-1: the ratio of slope to Vpe at RR-1 or RR-2=1 second, Vpe-1: Vpe at RR-1 or RR-2=1 second, r2: correlation coefficient, RR-2: pre-preceding RR interval, LV: left ventricular

Table 3
Relation of new parameters derived from the correlation between RR interval and LV outflow peak ejection velocity with clinical and echocardiographic variables in all patients
kcj-37-119-i003

*: p<0.05. Vpe: LV outflow peak ejection velocity, RR-1: preceding RR interval, RR-2: pre-preceding RR interval, Vpe-1: Vpe at RR-1 or RR-2=1 second, Slope/Vpe-1: the ratio of slope to Vpe at RR-1 or RR-2=1 second, CHF-Hx: history of congestive heart failure, LVIDd: diastolic dimension of left ventricle, LVIDs: systolic dimension of left ventricle, FS: fractional shortening, EF: ejection fraction, IVS: diastolic thickness of interventricular septum, LVPW: diastolic thickness of left ventricular posterior wall, LVM: left ventricular mass, MR: mitral regurgitation, AR: aortic regurgitation, LV: left ventricular

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