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Choi, Kim, Cho, Kim, Seo, Lee, Lee, Kim, Kim, Ko, Kim, and Ryu: Relationship Between RR Intervals and Early Diastolic Mitral Annulus Velocities in Atrial Fibrillation Patients Who do not Have Significant Valvular Diseases
Original Article
Korean Circulation Journal

Korean Circulation Journal 2008; 38(10): 551-556.

Published online: 30 October 2008

DOI: https://doi.org/10.4070/kcj.2008.38.10.551

Relationship Between RR Intervals and Early Diastolic Mitral Annulus Velocities in Atrial Fibrillation Patients Who do not Have Significant Valvular Diseases

Yeo Won Choi, MD, Jeong Eun Kim, MD, Eun Jung Cho, MD, Eun Young Kim, MD, Ki Woo Seo, MD, Kyung Heon 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.

Correspondence: Chee Jeong Kim, MD, Division of Cardiology, Department of Internal Medicine, College of Medicine, Chung-Ang University, 224-1 Heukseok 1-dong, Dongjak-gu, Seoul 156-755, Korea. Tel: 82-2-6299-1398, Fax: 82-2-822-2769, cjkim@cau.ac.kr

Received 29 April 2008       Revised 17 June 2008       Accepted 11 July 2008

Copyright © 2008 The Korean Society of Cardiology

Abstract

Background and Objectives

Irregular RR intervals in atrial fibrillation (AF) results in beat to beat changes in hemodynamical parameters. Early diastolic mitral annulus velocity (E') is one of the parameters that represent diastolic function of the left ventricle (LV). In this study, we have investigated the effects of continuous changes of systolic functions in AF on the diastolic functions of the LV.

Subjects and Methods

E' (35-40 beats) was recorded in 31 AF patients that did not have significant valvular heart diseases. The relationships between preceding RR intervals (RR-1) or pre-preceding RR intervals (RR-2) and E's were obtained using a logarithmic function.

Results

Slopes between RR-1 and E' varied from -1.62 to 1.04 in total coordinates. In the logistic regression analysis patients with negative slopes were found to have a larger left atrial size than patients with positive slopes (5.5±0.67 cm vs. 4.9±0.56 cm, p=0.02). Slopes were negatively related with mean RR intervals in the Pearson correlation analysis (r=-0.40, p=0.028). Slopes between RR-2 and E' were also variable and were not associated with other parameters.

Conclusion

Beat to beat changes in systolic functions derived from irregular RR intervals in AF had variable effects on diastolic functions among patients. The relationship between RR-1 and E' was associated with LA sizes and mean RR intervals.

Keywords: Left ventricular functions, Atrial fibrillation, Electrocardiography, Pulsed Doppler echocardiography

Figures and Tables

Fig. 1
Representative examples of negative (A) and positive (B) relationships between preceding RR intervals and early diastolic mitral annulus velocities.
kcj-38-551-g001
Fig. 2
Relationship of slopes between preceding RR intervals and early diastolic mitral annulus velocities with mean RR intervals (A) and left atrial (LA) sizes (B).
kcj-38-551-g002
Table 1
Clinical characteristics of patients
kcj-38-551-i001

LVIDd/LVIDs: left ventricular internal dimension diastolic/systolic, IVSd/LVPWd: diastolic thickness of interventricular septum/diastolic thickness of left ventricular posterior wall, AT: acceleration time, DT: deceleration time, ACE: angiotensin converting enzyme

Table 2
Comparisons between patients with negative and positive relationships between RR intervals and early diastolic mitral annulus velocities
kcj-38-551-i002

LVIDd: diastolic dimension of left ventricle, LVIDs: systolic dimension of left ventricle, FS: fractional shortening, IVS: diastolic thickness of interventricular septum, LVPW: diastolic thickness of left ventricular posterior wall, LA: left atrium, E: early diastolic mitral flow velocity, DT: deceleration time, E': early diastolic mitral annulus velocity

Table 3
Relationship of the slope derived from the correlation between RR intervals and early diastolic mitral annulus velocities with clinical and echocardiographic variables
kcj-38-551-i003

RR-1: preceding RR interval, RR-2: pre-preceding RR interval, LVIDd: diastolic dimension of left ventricle, LVIDs: systolic dimension of left ventricle, FS: fractional shortening, IVS: diastolic thickness of interventricular septum, LVPW: diastolic thickness of left ventricular posterior wall, LA: left atrium, DT: deceleration time

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