Korean Circ J.  2012 Sep;42(9):618-624. 10.4070/kcj.2012.42.9.618.

Relation Between RR Intervals and Early Diastolic Mitral Annular Velocities in Atrial Fibrillation

• Kim EY
• Choi YH
• Hyeon CW
• Cho JH
• Kim KJ
• Lee WS
• Lee KJ
• Kim SW
• Kim TH
• Kim CJ

• KMID: 2297893
• DOI: http://doi.org/10.4070/kcj.2012.42.9.618

Abstract

BACKGROUND AND OBJECTIVES
Irregular RR intervals in atrial fibrillation (AF) make beat-to-beat changes in left ventricular (LV) systolic performance. Early diastolic mitral annular velocity (E') is one of the well-established parameters for evaluating LV diastolic function. The relation between RR intervals and E's is unknown. The aim of this study was to observe the influence of continuous changes in RR interval on the parameter for diastolic function in AF.
SUBJECTS AND METHODS
Echocardiography was performed in 117 patients with AF. E' was adjusted for the effect of pre-preceding RR interval (RR-2) using the logarithmic equation between RR-2 and E'. The logarithmic equation between adjusted E' and preceding RR interval (RR-1) was calculated.
RESULTS
The slope in the relation between RR-1 and E' varied from -2.5 to 2.6. The slope was lower (more likely negative) in patients with higher ratio of early diastolic mitral flow velocity (E) to E' (r=-0.21, p=0.023), ischemic heart disease (IHD, r=0.21, p=0.026), and higher systolic blood pressure (r=-0.19, p=0.046). When patients were divided into these 3 groups on the basis of slope, the lowest slope group (<-0.55, n=39) was associated with higher E'/E (p=0.004) and IHD (p=0.018) compared with the highest slope group (>0.57, n=39). The slope with regards to the relationship between RR-2 and E' also varied from -3.4 to 3.1.
CONCLUSION
Changes in RR intervals had variable effects on E's according to clinical variables in AF.

Keyword

Ventricular function, left; Atrial fibrillation; Electrocardiography; Pulsed Doppler echocardiography; Heart rate

MeSH Terms

Atrial Fibrillation
Blood Pressure
Echocardiography
Echocardiography, Doppler, Pulsed
Electrocardiography
Heart Rate
Humans
Myocardial Ischemia
Ventricular Function, Left

Figure

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  Fig. 1 Examples of measuring pre-preceding RR interval (RR-2), preceding RR interval (RR-1), and early diastolic mitral valve annular velocity (E').

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  Fig. 2 Representative example of processes to obtain slope in the relation between preceding RR interval (RR-1) and early diastolic mitral valve annular velocity (E'). Logarithmic equation for the relationship between pre-preceding RR interval (RR-2) and E' (A). Relationship between RR-1 and E' before (B) and after (C) adjustment for effect of RR-2 on E'. Logarithmic equation between RR-1 and adjusted E' was recalculated in coordinates with RR-1 ranging from 0.6 to 1 second (D).

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  Fig. 3 The most negative and positive slopes in the relationship between preceding RR interval and E' (A and B) and in the relationship between pre-preceding RR interval and E' (C and D).

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  Fig. 4 The relationship between ratio of early diastolic mitral flow velocity to early diastolic mitral annular velocity (E/E') and slope with respect to the relationship between preceding RR interval and E'.

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  Fig. 5 Biphasic association between mean RR interval and slope in the relationship between preceding RR interval and early diastolic mitral annular velocity; Positive in co-ordinates with mean RR interval ≤0.8 second and negative in co-ordinates with mean RR interval ≥0.75 second with borderline statistical significance.

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