The impact of chronic heart failure on heart remodeling in patients with atrial fibrillation

Authors

DOI:

https://doi.org/10.14739/2310-1210.2021.4.229002

Keywords:

chronic heart failure, atrial fibrillation, cardial remodeling, systolic function

Abstract

Atrial fibrillation (AF) and chronic heart failure (CHF) often coexist due to common pathophysiological mechanisms and risk factors. However, the effect of CHF on heart remodeling in patients with permanent AF has been insufficiently studied.

The aim: to study the influence of CHF on changes in structural and geometric parameters and diastolic function of the heart in patients with permanent AF.

Materials and methods. The study included 100 patients (men – 60 % (n = 60); women – 40 % (n = 40)) with CHF of ischemic origin and AF, stage II AB, NYHA II-IV FC, and 16 coronary heart disease patients (men – 62.5 % (n = 10), women – 37.5 % (n = 6)) with AF without signs of CHF. Patients were comparable in age (P = 0.267), height (p = 0.406), weight (P = 0.518), body surface area (P = 0.388). Doppler echocardiography was performed on the device Esaote MyLab Eight (Italy) according to standard methods.

Results. Patients with AF and signs of CHF were dominated by individuals with eccentric hypertrophy (49 % vs. 19 %; P = 0.0270), and patients with AF without signs of CHF – with eccentric remodeling (0 % vs. 25 %; P = 0.0001). Patients with AF and signs of CHF had significantly higher systolic pressure in the pulmonary artery (54.85 ± 14.23 mm Hg vs. 42.99 ± 11.94 mm Hg; P = 0.028) and pulmonary capillary wedge pressure (PCWP) (12.18 (9.80; 15.33) mm Hg vs. 8.92 (7.62; 10.50) mm Hg; P = 0.005) than patients with AF without signs of CHF, indicating more pronounced pulmonary hypertension and a more significant increase in left atrium pressure. AF patients with signs of CHF demonstrated significantly higher left ventricle end-diastolic pressure (LVEDP), as evidenced by the parameters: E\E’ medial (9.87 ± 5.24 vs. 6.15 ± 1.39; P = 0.001), E/E’ mean (8.38 ± 4.21 vs. 6.06 ± 1.97; P = 0.005), e’ medial (9.96 ± 3.79 cm/s vs. 12.81 ± 3.60 cm/s; P = 0.004). AF patients with signs of CHF had decreased LV EF (55.58 ± 14.65 % vs. 65.44 ± 10.87 %; P = 0.006), systolic velocity of the medial fibrous ring of the mitral valve S (6.92 ± 2.41 cm/s vs. 8.40 ± 2.03 cm/s; P = 0.015), and significantly higher values of TEI RV (0.58 ± 0.16 c. u. vs. 0.48 ± 0.11 c. u.; P = 0.011), but decreased TAPSE values (16.22 ± 4.60 mm vs. 19.54 ± 5.00 mm; P = 0.067), indicating more pronounced systolic dysfunction of both ventricles.

Conclusions. Comorbidity of CHF and AF in patients is accompanied by the increased percentage of eccentric hypertrophy (49 %; P = 0.027), more pronounced systolic dysfunction of the left and right ventricles, increased LVEDP, PCWP, systolic pressure in the pulmonary artery, dilation of the inferior vena cava.

Author Biographies

V. А. Lysenko, Zaporizhzhia State Medical University, Ukraine

Postgraduate student of the Department of Propedeutic Internal Medicine, Radiation Diagnostic and Radiation Therapy

V. V. Syvolap, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Propedeutic Internal Medicine, Radiation Diagnostic and Radiation Therapy

References

Cuglan, B., Ermis, N., Yetkin, E., Karakus, Y., Kurtoglu, E., & Ozdemir, R. (2020). Evaluation of right ventricle systolic and diastolic function in patients with paroxysmal atrial fibrillation. Sanamed, 15(2), 131-137. https://doi.org/10.24125/sanamed.v15i2.417

Kotecha, D., & Piccini, J. P. (2015). Atrial fibrillation in heart failure: what should we do? European Heart Journal, 36(46), 3250-3257. https://doi.org/10.1093/eurheartj/ehv513

Taniguchi, N., Miyasaka, Y., Suwa, Y., Harada, S., Nakai, E., & Shiojima, I. (2020). Heart Failure in Atrial Fibrillation - An Update on Clinical and Echocardiographic Implications. Circulation Journal, 84(8), 1212-1217. https://doi.org/10.1253/circj.CJ-20-0258

Sartipy, U., Dahlström, U., Fu, M., & Lund, L. H. (2017). Atrial Fibrillation in Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction. JACC: Heart Failure, 5(8), 565-574. https://doi.org/10.1016/j.jchf.2017.05.001

Bavishi, A., & Patel, R. B. (2020). Addressing Comorbidities in Heart Failure: Hypertension, Atrial Fibrillation, and Diabetes. Heart Failure Clinics, 16(4), 441-456. https://doi.org/10.1016/j.hfc.2020.06.005

Ahn, M. S., Yoo, B. S., Yoon, J., Lee, S. H., Kim, J. Y., Ahn, S. G., Youn, Y. J., Lee, J. W., Son, J. W., Kim, H. S., Kang, D. R., Cho, H. J., Lee, H. Y., Jeon, E. S., Kang, S. M., Choi, D. J., & Cho, M. C. (2020). Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation. Heart, 106(4), 292-298. https://doi.org/10.1136/heartjnl-2019-315240

Denham, N. C., Pearman, C. M., Caldwell, J. L., Madders, G., Eisner, D. A., Trafford, A. W., & Dibb, K. M. (2018). Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure. Frontiers in Physiology, 9, Article 1380. https://doi.org/10.3389/fphys.2018.01380

Madan, N., Itchhaporia, D., Albert, C. M., Aggarwal, N. T., & Volgman, A. S. (2019). Atrial Fibrillation and Heart Failure in Women. Heart Failure Clinics, 15(1), 55-64. https://doi.org/10.1016/j.hfc.2018.08.006

Reddy, Y., Obokata, M., Verbrugge, F. H., Lin, G., & Borlaug, B. A. (2020). Atrial Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation. Journal of the American College of Cardiology, 76(9), 1051-1064. https://doi.org/10.1016/j.jacc.2020.07.009

Mohsen Ali Mahmoud Salama, Wael Mohammed Attia, & Mohamed Abdelaziz Mohamed. (2020). Assessment of Diastolic Dysfunction in Patients with Atrial Fibrillation. Al-Azhar International Medical Journal, 1(3), 309-313. https://doi.org/10.21608/AIMJ.2020.22090.1108

Voronkov, L. H., Amosova, K. M., Dziak, H. V., Zharinov, O. Y., Kovalenko, V. M., Korkushko, O. V., Nesukai, O. H., Sychov, O. S., Rudyk, Yu. S., & Parkhomenko, O. M. (2017). Rekomendatsii Asotsiatsii kardiolohiv Ukrainy z diahnostyky ta likuvannia khronichnoi sertsevoi nedostatnosti (2017) [Guidelines of the Ukrainian Association of Cardiology for the Diagnosis and Treatment of Chronic Heart Failure (2017)]. Sertseva nedostatnist ta komorbidni stany, (1, dodatok 1), 1-66. [in Ukranian].

Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F. A., Foster, E., Goldstein, S. A., Kuznetsova, T., Lancellotti, P., Muraru, D., Picard, M. H., Rietzschel, E. R., Rudski, L., Spencer, K. T., Tsang, W., & Voigt, J. U. (2015). Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28(1), 1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003

Gaasch, W. H., & Zile, M. R. (2011). Left Ventricular Structural Remodeling in Health and Disease: With Special Emphasis on Volume, Mass, and Geometry. Journal of the American College of Cardiology, 58(17), 1733-1740. https://doi.org/10.1016/j.jacc.2011.07.022

Goroshi, M., & Chand, D. (2016). Myocardial Performance Index (Tei Index): A simple tool to identify cardiac dysfunction in patients with diabetes mellitus. Indian Heart Journal, 68(1), 83-87. https://doi.org/10.1016/j.ihj.2015.06.022

Taniguchi, N., Miyasaka, Y., Suwa, Y., Harada, S., Nakai, E., Kawazoe, K., & Shiojima, I. (2019). Usefulness of Left Atrial Volume as an Independent Predictor of Development of Heart Failure in Patients With Atrial Fibrillation. The American Journal of Cardiology, 124(9), 1430-1435. https://doi.org/10.1016/j.amjcard.2019.07.049

Li, C., Zhang, J., Zhou, C., Huang, L., Tang, H., & Rao, L. (2010). Will simultaneous measurement of E/e' index facilitate the non-invasive assessment of left ventricular filling pressure in patients with non-valvular atrial fibrillation? European Journal of Echocardiography, 11(3), 296-301. https://doi.org/10.1093/ejechocard/jep218

Adhikaree, A., Malla, R., Sah, R., Maskey, A., Rajbhandari, S., Sharma, D., Gautam, B., & Najmy, S. (2019). Echocardiographic assessment of Diastolic Function in patients with Atrial Fibrillation. Nepalese Heart Journal, 16(2), 17-21. https://doi.org/10.3126/njh.v16i2.26312

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Published

2021-07-01

How to Cite

1.
Lysenko VА, Syvolap VV. The impact of chronic heart failure on heart remodeling in patients with atrial fibrillation. Zaporozhye Medical Journal [Internet]. 2021Jul.1 [cited 2024Dec.26];23(4):462-8. Available from: http://zmj.zsmu.edu.ua/article/view/229002

Issue

Vol. 23 No. 4 (2021)

Section

Original research

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