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1 Department of Cardiovascular Imaging Center, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
2 Section of Electrophysiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
* To whom correspondence should be addressed. E-mail: tommy{at}clin.med.tokushima-u.ac.jp.
Left ventricular (LV) diastolic function during atrial fibrillation (AF) remains poorly understood due to complex interaction of factors and beat-to-beat variability. The
purpose of the present study was to elucidate physiologic determinants of beat-to-beat changes in LV diastolic function during AF. The RR intervals preceding a given cardiac beat were measured from the right ventricular electrogram in 12 healthy open chest mongrel dogs during AF. Doppler echocardiography, and LV pressure and volume beatto-beat analysis were performed. The LV filling time (FT) and early diastolic mitral inflow velocity-time integral (Evti) were measured using the pulsed Doppler method. The LV end-diastolic volume (EDV), peak systolic LV pressure (LVP), minimum value of the first derivative of LV pressure curve (dP/dtmin) and the time constant (
) of LV pressure decay were evaluated using a conductance catheter for 100 consecutive cardiac cycles. Beat-to-beat analysis revealed a cascade of important causal relations. LV-FT showed a significant positive linear relationship with Evti(r = 0.87). Importantly, there was a significant positive linear relationship between the RR interval and LV-EDV in the same cardiac beat (r = 0.53). Consequently, there was a positive linear relationship between LV-EDV and subsequent peak systolic LVP (r = 0.82). Furthermore, there were
significant positive linear and negative curvilinear relationships between peak systolic LVP and dP/dtmin (r = 0.95) and (r = - 0.85), respectively, in the same cardiac beat. In addition, there was a significant negative curvilinear relationship between dP/dtmin and (r = - 0.86). We have concluded that determinants of LV diastolic function in individual beats during AF depend strongly on the peak systolic LVP. This suggests that major benefit of slower ventricular rate appears related to lengthening of LV filling interval, promoting subsequent higher peak systolic LVP and greater LV relaxation.
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