The main possible risk factors occurrence of atrial fibrillation in patients with heart failure preserved ejection fraction
L G Hazarapetyan, P H Zelveian, S V GrigoryanAbstract
Background
Heart failure (HF) is often accompanied by atrial fibrillation (AF), which significantly worsens the outcome of both diseases. Of particular interest is the appearance of AF in HFpEF. In this study, we aimed to identify possible risk factors contributing to the onset and progression of AF in patients with HFpEF.
Methods
We observed 316 patients with HFpEF during 3 years (retrospective study). The study included HFpEF patients with AF after successfully cardioversion (149 patients) and HFpEF patients without AF (167 patients) as a control group. All patients underwent the standart examination, including echocardiography, ambulatory blood pressure and Holter ECG monitoring. The inflammatory markers, such as high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), transforming growth factor-β1 (TGF-β1) and tissue factor (TF) measured using the ELISA method. The results obtained were analyzed using odds ratios (OR).
Results
The analysis OR of possible risk factors in HFpEF patients with AF relative to the control group the following significant risk factors identified: age (OR =1.18, p < 0.05) high diastolic blood pressure ( OR =2.96 p < 0.017), high body mass index (OR =1.13, p < 0.05 ), atrial electrical remodeling OR of Pmax = 1.18 p < 0.001; Pdis OR=4.51 p < 0.001) , left atrial volume ( OR= 2.76 p < 0.002) and left ventricular diastolic dysfunction (for isovolumetric relaxation time OR = 2.94, p< 0.016, for peak E OR = 2.05, p< 0.012) , for IVRT), for E/e’ divided by LA peak (OR= 1.72 р < 0.02 ) and E/e’ divided by LAEF OR=2.21, р<0.01). However, no significant changes in the OR of systolic dysfunction were observed in the comparable groups. Higher of hs-C RP (OR = 5.76, p <0.001), IL-6 (OR = 4.85, p < 0.001), and TF(OR= 2.29,p <0.02 )were associated with an increased risk of AF in HFpEF patients compared to similar patients without AF.
Conclusion
It could be considered that older age, arterial hypertension , heart diastolic dysfunction and increased levels of inflammatory and coagulation markers are possible risk factors for the occurrence of AF in HFpEF patients