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New insights linking endothelial dysfunction with atrial fibrillation

Session Poster session 5

Speaker Evangelos Oikonomou

Event : ESC Congress 2016

  • Topic : arrhythmias and device therapy
  • Sub-topic : Arrhythmias, General – Pathophysiology and Mechanisms
  • Session type : Poster Session

Authors : S Mazaris (Athens,GR), G Siasos (Athens,GR), K Zisimos (Athens,GR), E Oikonomou (Athens,GR), K Mourouzis (Athens,GR), T Zografos (Athens,GR), E Kokkou (Athens,GR), G Marinos (Athens,GR), G Lazaros (Athens,GR), D Tousoulis (Athens,GR)

S. Mazaris1 , G. Siasos1 , K. Zisimos1 , E. Oikonomou1 , K. Mourouzis1 , T. Zografos1 , E. Kokkou1 , G. Marinos1 , G. Lazaros1 , D. Tousoulis1 , 1Hippokration Hospital, University of Athens, 1st Department of Cardiology - Athens - Greece ,

European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 885-886

Introduction: Atrial fibrillation (AF) progress from paroxysmal to chronic (long standing persistent or permanent) over time. Endothelial dysfunction may be developed as a result of atrial fibrillation but may also contribute to the progression in the chronic form of the disease.

Purpose: To evaluate the association of endothelial function with the duration of AF

Methods: In this cohort study we enrolled 65 consecutive subjects with AF, 30 with paroxysmal and 35 with chronic AF. Flow mediated dilation (FMD) was measured as an index of endothelial function. Left ventricle ejection fraction (LVEF), left ventricle mass index to body surface area (LVmass/BSA), left atrial diameter index to body surface area (LAdiam/BSA) and left atrial volume index to body surface area (LAvol/BSA) were estimated with two dimensional echocardiography. Baseline demographic and clinical characteristic were assessed as well as the duration from the first presentation of AF.

Results: The duration of AF in subjects with chronic AF was range from 1–50 years and in subjects with paroxysmal AF from 0–17 years. Subjects with chronic AF compared to subjects with paroxysmal AF were older (p=0.02), had impaired LVEF (p=0.001) increased LAdiam/BSA (p<0.001), increased LAvol/BSA (p<0.001), increased LVmass/BSA (p=0.06) and impaired creatinine clearance (p=0.03). Importantly, subjects with chronic AF had impaired FMD compared to subjects with paroxysmal AF (4.79±1.03% vs. 7.02±1.24% p<0.001) and longer duration of AF [5 (2–13) vs. 1 (0–2), p<0.001]. Interestingly, stratified analysis revealed that only in subjects with chronic AF, the duration of AF was inversely associated with FMD (rho=-0.45, p=0.006). A linear regression model revealed that duration of chronic AF was inversely associated with FMD [b=-0.058 95% CI (-0.077 to -0.039), p<0.001] even after adjustment for confounders such as age, sex, LVEF, LVmass/BSA, LAvol/BSA, creatinine clearance, arterial hypertension and the presence of diabetes mellitus.

Conclusions: Endothelial function is impaired in subjects with AF and it further deteriorates over time in subjects with chronic AF. These findings highlight the detrimental effects of AF on vascular endothelium.

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