Relationship between Impairment of the Vascular Endothelial Function and the CHA₂DS₂-VASc Score in Patients with Sinus Rhythm and Non-valvular Atrial Fibrillation

Abstract

Objective and methods There is little information concerning the influence of the heart rhythm on the vascular endothelial function in patients with non-valvular atrial fibrillation (AF) compared with studies concerning sinus rhythm (SR). The present study included paroxysmal (n=184) or chronic (n=53) AF patients without heart failure and control subjects with SR (n=79) matched for age, gender and the CHA2DS2-VASc score. Paroxysmal AF was defined as episodes that terminated spontaneously within 7 days, while chronic AF was defined as longstanding AF that was refractory to cardioversion for 12 months or longer. There were no significant differences in the numbers of patients receiving renin-angiotension-aldosterone system inhibitors or statins among the three groups. Results Among the 237 AF patients (155 men, mean age 64±9 years, mean CHA2DS2-VASc score 1.8±1.4), the flow-mediated dilatation (FMD) was 5.4%±2.6% in the paroxysmal AF group, 4.3%±2.1% in the chronic AF group and 6.5%±3.5% in the SR group. There were significant differences among the 3 groups (all, p<0.05). Nitroglycerin-induced dilatation (NMD) was noted in 14.6%±6.5% of the paroxysmal AF group, 16.5%±9.1% of the chronic AF group and 12.7%±5.9% of the SR group, with no significant differences among the 3 groups. There was a significant negative correlation between the CHA2DS2-VASc scores and the FMDs value in all 3 groups (paroxysmal AF group:r=-0.322, p<0.01; chronic AF group:r=-0.291, p<0.05; SR group:r=-0.326, p<0.01). Conclusion In comparison with SR, the frequency and duration of AF episodes appear to cause deterioration of the vascular endothelial function.

A greater burden of atrial fibrillation is associated with worse endothelial dysfunction in hypertension

“…The results are consistent with other studies looking at FMD in hypertension and AF individually and confirms that endothelial dysfunction is present. 9,[13][14][15][16]21 Our findings extend previous work by demonstrating that the presence of AF generally does not incrementally worsen endothelial dysfunction, nor was AF an independent predictor of endothelial dysfunction on multivariate analysis. However, permanent AF compared to paroxysmal AF does have significantly worse FMD parameters with permanent AF being an independent predictor on multivariate analysis.…”

“…[9][10][11][12] FMD is also found to be impaired in patients with AF. [13][14][15][16] Since AF and hypertension, commonly co-exist, we hypothesised that endothelium-dependent FMD will be reduced in patients with AF (and hypertension) compared to hypertensive controls and this may partly explain the poor prognosis in such patients.…”

Endothelial dysfunction and vascular maladaptation in atrial fibrillation

“…Several studies support the notion that AF patients demonstrate an impaired FMD 7,8 . Indeed, Komatsu et al found that FMD also related to AF severity, with an FMD of 6.5 ± 3.5% in non‐AF individuals, 5.4 ± 2.6% in paroxysmal AF patients, and 4.3 ± 2.1% in chronic AF patients 9 . A 1% drop in FMD relates to a 13% increase in cardiovascular risk 10 .…”

“…7,8 Indeed, Komatsu et al found that FMD also related to AF severity, with an FMD of 6.5 ± 3.5% in non-AF individuals, 5.4 ± 2.6% in paroxysmal AF patients, and 4.3 ± 2.1% in chronic AF patients. 9 A 1% drop in FMD relates to a 13% increase in cardiovascular risk. 10 The impaired FMD in AF patients may be restored following cardioversion, 8 with preserved FMD after catheter ablation if sinus rhythm is maintained.…”

Atrial Electromechanical Delay Is Impaired in Patients with Primary Hyperparathyroidism

“…Atrial fibrillation (AF) is an important heart rhythm disorder common in clinical practice, which causes hemodynamic disorders, frequent hospitalizations, and thromboembolic events, and affects 1-2% of the general population (3). Although the exact mechanisms causing AF are not fully understood, hypertension, heart failure, diastolic dysfunction, endothelial dysfunction and left ventricular hypertrophy play an important role in the pathogenesis of AF (3,4 ). Side effects such as hypertension, diastolic dysfunction, endothelial dysfunction, left ventricular hypertrophy can also be seen in PHPT disease (2) .…”