title: Is echocardiography valid and reproducible in patients with atrial fibrillation? A systematic review.
abstract: OBJECTIVE
  Echocardiography is vital in the routine assessment and management of atrial fibrillation (AF). We performed a systematic review of the validity and reproducibility of echocardiographic left ventricular systolic and diastolic function in AF, and optimal acquisition methods.
  
  
  RESULTS
  Online databases were searched for studies in patients with AF at the time of echocardiography (1960 to August 2015), prospectively registered with PROSPERO (CRD42015025297). The systematic review included 32 studies from 3 066 search results (1 968 patients with AF). Average age was 67 years, 33% were women, mean LVEF 53% (±10%), and average E/e' 11.7 (±2.7). Data on the validity and reproducibility of systolic indices were extremely limited. In contrast, diastolic parameters demonstrated correlation with invasive filling pressure and adequate reproducibility: E/e' (n = 444) r = 0.47 to 0.79; IVRT (n = 177) r = -0.70 to -0.95; E/Vp` (n = 55) r = 0.63 and 0.65; pulmonary vein diastolic flow (n = 67) r = -0.80 and -0.91. Elevated E/e' (>15) was associated with functional capacity, quality of life, and impaired prognosis. For optimal acquisition in AF patients, cardiac cycles with controlled heart rate (<100 beats/min) and similar preceding and pre-preceding RR intervals are required. Cardiac cycle length and equivalence were more important than the number of beats averaged.
  
  
  CONCLUSIONS
  With careful selection of appropriate cardiac cycles, echocardiography is a valid tool to identify diastolic dysfunction in AF, and E/e' is an independent marker of clinical status and adverse prognosis. However, data on systolic function was extremely limited and requires further prospective study and assessment of variability in clinical practice.
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK.|Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia.|Department of Cardiology, University Hospitals Birmingham NHS Trust, Birmingham, UK.
authors.forename: Dipak
authors.initials: D
authors.lastname: Kotecha
authors.affiliation: Department of Cardiology, East Kent Hospitals University NHS Trust, Ashford, UK.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mohamed
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK.
authors.forename: Eduard
authors.initials: E
authors.lastname: Shantsila
authors.affiliation: University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, and Institute of Cardiovascular Diseases 'Prof. C. C. Iliescu' Bucharest, Romania.
authors.forename: Bogdan A
authors.initials: BA
authors.lastname: Popescu
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK.|Department of Cardiology, University Hospitals Birmingham NHS Trust, Birmingham, UK.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Steeds
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013318:Stroke Volume; D013599:Systole; D016277:Ventricular Function, Left
keywords: Atrial fibrillation; Diastolic; Echocardiography; Ejection fraction; Heart failure; Reproducibility; Systematic review