The role of some additional risk factors in the occurrence of paroxysmal / persistent atrial fibrillation in patients with arterial hypertension

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Arterial hypertension (AH) and atrial fibrillation (AF) are two important public health problems and often coexist in the same patient. AH ultimately increases the risk of AF and several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. AH is one of the main reasons for the remodeling process in these patients and makes a significant contribution to the development of structural changes. The aim of this study is to identify predictors of paroxysmal/persistent AF occurrence and progression in hypertensive patients Methods In this study where enrolled 109 hypertensive patients with non-valvular paroxysmal/persistent AF (mean age 61.6 ±6.4) who were hospitalized at Institute of Cardiology between 2008 and 2016 year. As a control group, 44 hypertensive patients without AF were also examined. The study lasted 8 years. After the enrollment the echocardiography examination and 24-hour ambulatory Holter monitoring ECG were registered in each patient. We measured plasma indexes of inflammation (hsCRP, IL-6) and fibrosis marker - transforming growth factor (TGF-β1). The database consisting of 33 indicators that characterize the clinical, hemodynamic and structural-functional state of the heart, as well as markers of inflammation and fibrosis was created. .All data were analyzed by SPSS 13 and EXCEL - 2013 programs using logistic analysis by odds ratio (OR). Results The comparative results of clinical, hemodynamic, inflammation and fibrosis markers OR with AF in hypertensive patients relative to the control group showed that in hypertensive patients with AF there was a significant increase in diastolic pressure (OR 1.09, р=0.017) , the number of hypertensive crises episodes ( OR 1.56 р=0.001) and patients of older age groups (OR 1.18, р= 0.001) There was a significant deterioration in electrical remodeling (Pmax 3.92, р=0.001, P dispersion 4.90, р=0.001), LV diastolic function (isometric ventricular contraction time 1.69, р=0.042) and of left atrial volume (OR 3.69, р=0.001). There were significant increases in levels of inflammatory and fibrosis markers concentrations in comported with hypertensive patients without AF (OR of hsСRP 5.57, р=0.01; IL-6 4.80, р=0.001 and TGF-β1 3.84, р=0.005). Conclusions The multifactorial analysis revealed that increased diastolic pressure, frequency of hypertensive crises, age, deterioration of diastolic function, as well as an increase in markers of inflammation and fibrosis concentration are additional risk factors for AF in patients with hypertension.