To Evaluate The Heart Function Of Patients With Chronic Atrial Fibrillation Applying Heart Failure Echocardiography Index

【Objective】: Applying heart failure echocardiography index (HFEI), which synthesizes the multinomial parameters of echocardiography, evaluates synthetically the diastolic and systolic function of patients with chronic atrial fibrillation (AF). Investigate primarily the alterations of HFEI and plasma brain natriuretic peptide (BNP) levels in patients with rapid AF and preserved left ventricular systolic function (LVEF>50%) before and after controlling ventricular rate.【Methods】: Prospectively we studied 133 patients with chronic AF and 28 normal controls. All the subjects were scored by HFEI, graded by NHYA and simultaneously BNP were measured. 18 patients with rapid AF and preserved left ventricular systolic function were carried out the therapy of controlling ventricular rate. 1. Appraise the sensitivity, specificity, positive predictive value and negative predictive value of HFEI in patients with chronic AF and heart failure. 2. Analyze the correlation between HFEI and NYHA class. 3. Analyze the correlation between HFEI and BNP. 4. Study the correlation of BNP with echocardiographic parameters. 5. Investigate primarily the alterations of HFEI and plasma BNP levels in patients with rapid AF and preserved left ventricular systolic function before and after controlling ventricular rate.【Results】: 1. The HFEI of AF group was significantly higher than that of control group (p<0.001). When cutoff point was three, the sensitivity, specificity, positive predictive value and negative predictive value of HFEI for diagnosing heart failure in patients with chronic AF were 86.4%, 94.1%, 96.9%,76.2%. 2. HFEI increased with the worsened NYHA class. The result analyzed by ANOVA showed that HFEI among NHYA class I, II, III, IV had remarkable difference (p<0.05). HFEI of NYHA class I, II, III, IV was 1.74±0.81, 2.83±0.88, 4.14±1.29, 6.38±1.14 respectively. There was remarkable positive correlation between HFEI and NYHA class(r=0.814, p<0.001), which was higher than the correlation of left ventricular ejection fraction (LVEF) or the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/Ea) with NYHA class (r respectively -0.567, 0.679, p<0.001). 3. There was remarkable positive correlation between HFEI and lnBNP (r=0.855, p<0.001), which was higher than the correlation of LVEF or E/Ea with lnBNP (r respectively -0.489, 0.686, p<0.001) in AF group. Even in AF subgroup with preserved left ventricular systolic function, the correlation of HFEI with lnBNP (r=0.757, p<0.001) was higher than that of E/Ea with lnBNP (r=0.56, p<0.001). 4.There was remarkable correlation between lnBNP and the multinomial parameters of echocardiography which reflected the cardiac systolic and diastolic function, in the multiple stepwise regression analysis, only LVEF, E/Ea, left atrium diameter (LAD), pulmonary artery pressure (PAP) were independent correlative makers for lnBNP in AF group. 5. After succeeding controlling ventricular rate of patients with rapid AF and preserved left ventricular systolic function, BNP decreased remarkably (median 198 vs 127pg/ml, p<0.001), as did HFEI (3.67±1.19 vs 2.72±0.83,p<0.001) and the multinomial parameters of echocardiography (such as E/Ea, LAD, PAP).【Conclusion】: It is feasible to evaluate the global heart function of patients with chronic AF applying HFEI. There was higher correlation of HFEI with NYHA class or BNP than that of LVEF or E/Ea with them. Ventricular rate control can improve heart function of patients with rapid AF, and HFEI may be used to appraise the curative effect.