Ventricular-arterial coupling changes as an early predictor of left ventricular remodelling in atrial fibrillation

Abstract

Abstract Objective Atrial fibrillation (AF) can be associated with adverse atrial and ventricular remodelling also in the absence of persistently elevated heart rate. Ventricular–arterial coupling (VAC) plays a pivotal role in cardiac and aortic adaptation to pathophysiological conditions. The aim of this study was to investigate changes in conventional and novel VAC indexes in long lasting paroxysmal AF. Methods Participants with paroxysmal AF, in sinus rhythm on admission, with preserved left ventricle (LV) systolic function and carotid – femoral pulse wave velocity (PWV) within normal range were carefully selected from consecutive patients admitted to University Hospital in Krakow for scheduled AF ablation. We excluded those with established coronary artery disease, moderate or severe heart valves disease, with uncontrolled hypertension or other comorbidities. The anthropometric and demographic data, medical history, and habits were collected using standardized questionnaire. A total of 51 (mean age 57.7 yrs; 37 men) patients underwent simultaneous echocardiographic and arterial data acquisition. End-systolic pressure was determined from central pulse wave analyses. Arterial elastance (Ea) and LV elastance (Ees) were calculated as end-systolic pressure/stroke volume and end-systolic pressure/end-systolic volume. Two-dimensional speckle tracking was used to derive LV global longitudinal strain (GLS), and then PWV to GLS ratio was calculated. Results Patient presented moderate (EHRA class median = 2b) and long-lasting symptoms (median of AF history 3 years). There was an association of Ees (parameter estimate (PE) 0.12; P=0.0004) and VAC (Ea/Ees) (PE=−0.13; P=0.33) with duration of AF history in the univariate linear regression model and this association retain statistically significant in a model including age, sex, history of hypertension and hypercholesterolemia. Longer history of AF was related to lower PWV to GLS ratio, however this association reached statistical significance only among patients with AF lasting more than 3 years (PE=−0.14; P=0.024) and persisted significant after accounting for covariates. Conclusion The relationship between AF and LV dysfunction is complex and potentially bi-directional. Paroxysmal AF however, can contribute to abnormality in heart–vessel coupling, even when LV function remained within the normal range, indicating early stage of ventricular remodelling due to arrythmia. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Collegium Medicum, Jagiellonian University, Krakow