Echocardiographic Indices of Diastolic Function Relate to Functional Capacity and Quality of Life in Ambulatory Men with Atrial Fibrillation Shahnaz Punjani, MD, Wen-Chih Wu, MD, Scott Cohen, MD, Satish C. Sharma, MD, and Gaurav Choudhary, MD, Providence, Rhode Island Objective: We sought to explore the reliability of echocardiographic parameters of diastolic function and determine their relationship with functional capacity (New York Heart Association [NYHA] class and 6-minute walk test [6MWT]) and the domains of a health-related quality of life (HR-QOL) questionnaire (Veterans RAND 36-Item Health Survey) in a cohort of ambulatory patients with atrial fibrillation (AF). Methods: Forty-eight male veterans with persistent or permanent AF underwent clinical examination, echocardiography, and 6MWT, and filled out a Veterans RAND 36-Item Health Survey questionnaire at two visits 1 week apart. Pairwise correlation was performed to evaluate the reliability of echocardiographic param- eters and multiple regression analyses to assess the association of these parameters with functional capacity and HR-QOL. Results: E/e’ average had the highest correlation between the two visits (coefficient: 0.87) and had a significant relationship with NYHA, 6MWT, and physical functioning domain of HR-QOL even after adjusting for confounding variables (odds of NYHA >1: OR 1.5, 95% CI, 1.2–1.9; 6MWT coefficient: 31 6 9 ft; physical functioning score coefficient: 1.7 6 0.7). Conclusion: Average E/e’ is a reliable diastolic function parameter that also independently relates with functional capacity and HR-QOL in ambulatory patients with atrial fibrillation. (J Am Soc Echocardiogr 2011;24:533-40.) Keywords: Atrial fibrillation, Diastolic dysfunction, Functional capacity, Quality of Life, Tissue Doppler Both diastolic heart failure (DHF) and atrial fibrillation (AF) are com- mon diseases in the elderly. 1-3 DHF refers to a clinical syndrome in patients with symptoms and signs of heart failure with preserved left ventricular (LV) systolic function and evidence of diastolic dysfunction, 4-6 and constitutes approximately half of all patients with heart failure. 2,7,8 Patients with DHF have a poor quality of life (QOL), 9 decreased exercise tolerance, 10 significant comorbidity, high readmission rate, and mortality rate that is similar to those with systolic heart failure. 8,11 Similarly, patients with AF have a poor QOL, 12-14 decreased exercise capacity, 15 and an increased risk of death from heart failure. 16 AF occurs in up to one quarter of patients with heart failure with preserved LV systolic function. 17,18 Thus, DHF and AF frequently coexist and interact in affecting functional tolerance, QOL, morbidity, and mortality. The main cause of DHF is presumed to be diastolic dysfunction as a result of abnormalities in relaxation or compliance (restriction) of the LV during diastole. Diastolic dysfunction in AF has been related to outcomes such as heart failure and death. 19-21 Echocardiographic indicators of diastolic function that have been studied include LV wall thickness, left atrial (LA) volume, ratio of transmitral Doppler inflow velocity patterns (E) and tissue Doppler velocities of the mitral annulus (e’), deceleration time (DT) of mitral inflow velocity, and ratio of E to the color M-mode flow propagation velocity (Vp), 22,23 among others. Although these parameters are well validated with clinical outcomes in patients with sinus rhythm, 24-26 these conventional methodologies have not been thoroughly studied in patients with AF, who have variable cycle length that may affect the reproducibility of these measurements. Although studies have correlated some of the Doppler parameters with invasive hemodynamics, 27-29 which may not necessarily reflect symptoms or clinical status, there are limited data in support of relationship of echocardiographic parameters of diastolic function with functional tolerance and QOL in patients with AF. This study sought to explore the reliability of echocardiographic parameters of diastolic dysfunction and determine which From the Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island (S.P., W-C.W., S.C., S.C.S., G.C.); and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (S.P., W-C.W., S.C., S.C.S., G.C.). This material is based on work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development: Biomedical Laboratory Research and Development Service (CDA-2 Award to G.C.); and Re- search Enhancement Award Program grant (REA 08-263) from the VA Health Ser- vices Research and Development Service (W-C.W.). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. Reprint requests: Gaurav Choudhary, MD, Providence VA Medical Center, 830 Chalkstone Ave. Providence RI 02908 (E-mail: Gaurav_choudhary@brown.edu). 0894-7317/$36.00 Copyright 2011 by the American Society of Echocardiography. doi:10.1016/j.echo.2011.01.008 533