Table 1.
Summary of included studies
| Study | Number with AF | Population | Relevant topic(s) | Aims and methods | Main findings related to AF |
|---|---|---|---|---|---|
| Belenkie, 19798 | 11 | Patients with sinus rhythm and AF, excluding technically inadequate echocardiograms. | Acquisition. | Association of end diastolic dimension and cycle length with M-mode parameters of LV systolic function. | Preload and cycle length correlated with LVEF. Patients with AF had higher correlation of RR interval with LVEF than patients with sinus rhythm. |
| Benyounes, 20159 | 17 | Consecutive patients including those with AF, but no important variability in heart rhythm. | Systolic validity. | Internal validation of strain measurement against LVEF. | High correlation of strain and LVEF in AF patients, and probably similar to sinus rhythm. |
| Chirillo, 199710 | 35 | AF for >3 months without mitral stenosis, undergoing catheterization on intensive care or electively. | Diastolic validity. | Correlation of invasive PCWP with mitral and PV flow velocities and derivation of non-invasive algorithm. | Diastolic PV flow better than mitral indices for estimating PCWP in AF. |
| Diwan, 200511 | 13 | Consecutive patients with mitral valve disease undergoing catheterization. | Diastolic validity. | Correlation of invasive PCWP with Doppler indices of diastolic function. | The ratio of IVRT to the time period between E and e’ highly correlated with PCWP in AF, similar to sinus rhythm. |
| Dubrey, 199712 | 21 | Selected AF patients with irregularity of rate on electrocardiogram. | Systolic reproducibility and acquisition. | Variability in LV outflow tract Doppler in AF compared to sinus rhythm. | 13 beats required in AF to achieve variability <2%, compared to 4 beats in sinus rhythm. |
| Galderisi, 199213 | 12 | Patients randomly selected from the Framingham cohort with heart rate <100 beats/min and technically adequate Doppler. | Diastolic reproducibility. | Reproducibility of Doppler indices of diastolic function in sinus rhythm and AF. | Variability similar in AF and sinus rhythm. Reproducibility highest for peak velocity and area under the curve rather than slope measures. |
| Kerr, 199814 | 38 | Consecutive non-valvular AF patients with good quality echocardiography. | Acquisition. | Impact of heart rate cycle length variability on LV outflow tract Doppler. | Variability in stroke volume increased at higher heart rates in AF. |
| Kusunose, 200915 | 56 | Non-valvular AF patients with preserved systolic function (n = 21 with simultaneous catheterization). | Diastolic validity and reproducibility. | Validation of single-beat E/e’ recorded by synchronous dual Doppler. | Single-beat lateral E/e’ a reliable indicator of elevated PCWP and plasma BNP in AF patients. |
| Kusunose, 201216 | 25 | Prospective assessment of non-valvular AF patients referred for catheterization. | Systolic reproducibility and acquisition. | Validation of an index-beat assessment vs. 10-s average for myocardial strain and strain rate. | A single index-beat (with similar preceding and pre-preceding RR intervals) was accurate compared to averaged mean values. |
| Lee, 200517 | 73 | Non-valvular chronic AF with heart rate ≤100 beats/min and clinically stable. | Systolic and diastolic validity. | Correlation of clinical and echocardiographic parameters with maximum symptom-limited treadmill. | E/e’ significantly related to exercise capacity in AF, unlike other echocardiographic parameters. |
| Lee, 200818 | 330 | Multicentre consecutive patients with persistent AF, LVEF >40% and heart rate ≤100 beats/min. | Systolic and diastolic validity. | Identification of echocardiographic risk factors for retrospective ischaemic stroke. | E/e’ significantly associated with prior stroke in AF patients with LVEF >40%. |
| Lee, 201219 | 98 | Prospective study of persistent or permanent AF patients with heart rate ≤105 beats/min. | Systolic reproducibility and acquisition. | Validation of index-beat measurement of LV peak longitudinal systolic strain. | A single index-beat was accurate compared to averaging multiple cardiac cycles. |
| Li, 201020 | 49 | Non-valvular AF patients with preserved ejection fraction undergoing catheterization. | Diastolic validity and reproducibility. | Correlation of single-beat E/e’ with invasive PCWP. | Stronger association between E/e’ and PCWP using a single-beat, dual Doppler method. |
| Matsukida, 200121 | 32 | Chronic AF patients undergoing catheterization. | Diastolic validity and reproducibility. | Correlation of diastolic indices with invasive PCWP. | PV flow and deceleration time independently associated with PCWP. |
| Nageuh, 199622 | 60 | Non-valvular AF patients (majority intensive care or surgical patients). | Diastolic validity and reproducibility. | Correlation of diastolic indices with invasive PCWP in training and test groups. | Diastolic indices (e.g. IVRT) highly correlated with PCWP, particularly in AF patients with LVEF <45%. |
| Okura, 200623 | 230 | Retrospective analysis of consecutive non-valvular AF patients. | Diastolic validity and reproducibility. | Assessment of E/e’ at a cut-point of 15 as a predictor of mortality over a follow-up period of 245 (± 200) days. | AF patients with E/e’ >15 have higher mortality, independent of clinical factors. |
| Oyama, 200424 | 68 | Non-valvular chronic AF patients. | Diastolic validity and reproducibility. | Correlation of E/Vp using single-beat dual Doppler with plasma BNP concentration and invasive PCWP. | E/Vp associated with both BNP and PCWP. |
| Peltier, 200825 | 40 | Prospective assessment of patients with non-valvular AF > 1 month and LVEF <40%, hospitalized for heart failure. | Diastolic validity and reproducibility. | Correlation of E/e’ with functional capacity and quality of life. | Deceleration time <150ms was independently associated with mortality in both AF and sinus rhythm. |
| Punjani, 201126 | 48 | Retrospective analysis of persistent or permanent AF with LVEF ≥50% and heart rate ≤100 beats/min. | Diastolic validity and reproducibility. | Determine relationship between diastolic parameters and functional capacity/quality of life, when measured on two different occasions 1 week apart. | E/e’ independently associated with walk distance and quality of life in patients with AF and preserved LVEF. |
| Schneider, 199728 | 18 | Chronic AF patients during routine echocardiography. | Acquisition. | Test hypothesis that LV systolic function is affected by pre-preceding cycle length. | Pre-preceding RR interval has an important effect on LV peak ejection velocity. |
| Senechal, 200827 | 24 | Consecutive early post-operative patients with predominantly paroxysmal AF and no mitral prosthesis. | Diastolic validity, diastolic reproducibility and acquisition. | E/e’ for estimating invasive PCWP with comparison of 10-beat average and one cycle with the longest R-R interval. | E/e’ with a single cardiac cycle had similar correlation with PCWP as averaged measures. |
| Shahgaldi, 201029 | 23 | Consecutive patients referred for echocardiography. | Systolic reproducibility. | Comparison of 1-beat and 4-beat 3D volumes and LVEF in patients with sinus rhythm and AF. | Lower variability in 3D full volume acquisition in AF patients using a 1-beat rather than 4-beat acquisition. |
| Sohn, 199930 | 27 | Non-valvular AF patients undergoing catheterization. | Diastolic validity. | Correlation of E/e’ with invasive PCWP. | E/e’ highly correlated with PCWP. |
| Su, 201131 | 54 | Consecutive patients with permanent AF and adequate echocardiographic images. | Systolic reproducibility. | Validation of pre-ejection period myocardial performance index with other indices of systolic and diastolic function in AF. | Pre-ejection period myocardial performance index is an indicator of global LV function in permanent AF. |
| Su, 201332 | 196 | Prospective assessment of consecutive patients with persistent AF and adequate images. | Systolic validity and reproducibility. | Ability of global longitudinal strain to predict cardiovascular events over follow-up of 21 (±10) months. | Global longitudinal strain improved prediction of adverse events beyond LVEF and tissue Doppler assessment. |
| Temporelli, 199934 | 35 | Patients with heart failure, LVEF <35%, AF > 3 months and acceptable images. | Diastolic validity and reproducibility. | Correlation of diastolic indices with invasive PCWP. | Deceleration time was independently associated with PCWP in AF patients with severe LV dysfunction. |
| Thavendiranthan, 201233 | 24 | Subgroup of patients with AF referred for an echocardiogram (main study outcomes investigated patients with sinus rhythm). | Systolic validation. | Assessment of an automated edge contouring algorithm using real-time 3D acquisition, compared to conventional biplane Simpsons. | Automated 3D LVEF in AF patients correlated well with conventional LVEF analysis. |
| Traversi, 200135 | 51 | Patients with heart failure, LVEF <35%, AF > 3 months and heart rate <90 beats/min, as part of a pre-transplant evaluation. | Diastolic validity and reproducibility. | Correlation of diastolic indices with invasive PCWP. | Mitral and PV flow indices correlate with PCWP in AF patients assessed for heart transplantation. |
| Wada, 201236 | 45 | Non-valvular chronic AF patients with normal right ventricular function. | Diastolic validity and reproducibility. | Correlation of single-beat dual Doppler with invasive PCWP. | The time and ratio between E and e’ correlated with PCWP, similar to BNP. |
| Wang, 200437 | 40 | Consecutive patients with AF and adequate acoustic windows. | Acquisition. | Evaluation of LVEF and stroke volume according to preceding cycle lengths. | Positive relationship between preceding cycle length and stroke volume. |
| Wang, 200538 | 100 | Consecutive AF patients referred for echocardiogram with adequate acoustic windows. | Acquisition. | Evaluation of aortic time-velocity integral according to preceding cycle length and varying beat repeats. | Assessment improved with cycle lengths >500ms and 2 or 3 beats with similar RR interval. |
| Wang, 200639 | 75 | Patients with AF referred for echocardiography with adequate acoustic windows. | Systolic reproducibility and acquisition | Improvement of systolic function evaluation according to cycle lengths and number of repeated beats. | LVEF and stroke volume can be reliably obtained in AF by averaging two beats with similar preceding and pre-preceding RR intervals and cycle length >500 ms. |
3D, Three-dimensional; AF, atrial fibrillation; BNP, B-type natriuretic peptide; IVRT, isovolumic relaxation time; LV, left ventricular; LVEF, left ventricular ejection fraction; PCWP, pulmonary capillary wedge pressure; PV, pulmonary vein.