Clinical Research
Arterial Stiffness Is Associated With Increased Symptom Burden in Patients With Atrial Fibrillation

https://doi.org/10.1016/j.cjca.2020.08.022Get rights and content

Abstract

Background

Increased arterial stiffness (AS) has been described as a predictor of atrial fibrillation (AF). This study was performed to assess whether increased AS leads to a higher symptom burden in patients with AF.

Methods

One hundred sixty-two consecutive patients (104 male, 58 female) with diagnosed AF (paroxysmal or persistent) were enrolled. Symptoms most likely attributable to AF were quantified according to the Canadian Cardiovascular Society Severity of Atrial Fibrillation (SAF) scale. AS indices (aortic distensibility, cyclic circumferential strain, and aortic compliance) were characterized using transoesophageal echocardiography.

Results

The cohort was divided into asymptomatic to oligosymptomatic (SAF scale 0-1, n = 78 [48.1%]) and symptomatic (SAF scale ≥ 2, n = 84 [51.9%]) patients. Symptomatic patients tended to be younger (median, 75 [interquartile range (IQR) 67-80] vs 71 [65-79]; P = 0.047) and were more likely to be female (22 [28.2%] vs 36 [42.9%]; P = 0.052). Hypertension was more frequent in symptomatic patients. Aortic compliance indices each were reduced in symptomatic patients, most pronounced for aortic compliance (median, 0.05 [IQR 0.03-0.06] vs 0.04 [0.03-0.05] cm/mm Hg; P = 0.01) followed by cyclic circumferential strain (median, 0.09 [IQR 0.07-0.11] vs 0.07 [0.04-0.10]; P = 0.02) and aortic distensibility (10−3 mm Hg−1, median, 1.74 [IQR 1.34-2.24] vs 1.54 [1.12-2.08]; P = 0.03). Multivariable analysis revealed aortic compliance as an independent predictor for symptoms in patients with AF with an odds ratio of 2.6 (95% confidence interval, 1.2-3.4; P = 0.003).

Conclusions

AS contributes to a high symptom burden in patients with AF, emphasizing the prognostic role of AS in the early detection and prevention in patients with AF.

Résumé

Contexte

L'augmentation de la rigidité artérielle (RA) a été décrite comme un prédicteur de la fibrillation auriculaire (FA). Cette étude a été réalisée pour évaluer si l'augmentation de la RA entraîne une augmentation de la contrainte liée aux symptômes chez les patients atteints de FA.

Méthodes

Cent soixante-deux patients successifs (104 hommes, 58 femmes) pour lesquels une FA a été diagnostiquée (paroxystique ou persistante) ont été recrutés. Les symptômes les plus à même d’être attribués à la FA ont été quantifiés selon l'échelle de sévérité de la fibrillation auriculaire (SFA) de la Société canadienne de cardiologie. Les indices de RA (distension de l’aorte, contrainte circonférentielle cyclique et compliance aortique) ont été caractérisés à l'aide d'une échocardiographie transœsophagienne.

Résultats

La cohorte a été divisée entre patients asymptomatiques avec peu de symptômes (échelle SFA 0-1, n = 78 [48,1%]) et symptomatiques (échelle SFA ≥ 2, n = 84 [51,9%]). Les patients symptomatiques étaient généralement plus jeunes (médian, 75 [intervalle interquartile (IIQ) 67-80] contre 71 [65-79] ; P = 0,047) et étaient le plus souvent des femmes (22 [28,2 %] contre 36 [42,9 %] ; P = 0,052). L'hypertension était plus fréquente chez les patients symptomatiques. Les indices de compliance aortique étaient tous réduits chez les patients symptomatiques, de façon plus prononcée concernant la compliance aortique (médian, 0,05 [IIQ 0,03-0,06] contre 0,04 [0,03-0,05] cm/mm Hg; P = 0,01), suivie par la contrainte circonférentielle cyclique (médian, 0,09 [IIQ 0,07-0,11] contre 0.07 [0,04-0,10]; P = 0.02) et la distension aortique (10-3 mm Hg-1, médian, 1,74 [IIQ 1,34-2,24] contre 1,54 [1,12-2,08]; P = 0,03). L'analyse multivariable a révélé la compliance aortique comme prédicteur indépendant en ce qui concerne les symptômes chez les patients souffrant de FA avec un rapport de cotes de 2,6 (intervalle de confiance à 95 %, 1,2-3,4; P = 0,003).

Conclusions

La RA contribue à une charge symptomatique élevée chez les patients atteints de FA, ce qui souligne le rôle pronostique de la RA dans la détection précoce et la prévention chez les patients atteints de FA.

Section snippets

Trial registration

This trial is registered in the German registry for clinical studies (DRKS00019007).

Study design

The study design complies with the declaration of Helsinki and was approved by the local ethical committee, Medical Ethic Commission II, Faculty of Medicine Mannheim, University of Heidelberg, Germany. Data protection was in accordance to the European Union Data Protection Directive.

Data statement

Data will be made available upon reasonable request.

Setting

One hundred sixty-two consecutive patients with paroxysmal or persistent AF

Results

The study group consisted of 162 patients. Thirty patients (18.5%) reported absolutely no symptoms and were therefore considered asymptomatic. Forty-eight patients (29.6%) had mild symptoms, that they associated with AF. Although 8 patients (4.9%) reported moderate symptoms, most of the study population (70 patients; 43.2%) complained of severe symptoms. Only 6 patients (3.7%) reported disabling symptoms (Table 1).

The study population represents a classic cardiological collective, with a median

Discussion

The results of the present study show an association between increased AS and a higher symptom burden in patients with AF. Because no continuous rhythm recording was performed to provide a symptom:rhythm correlation, we cannot say for certain whether the described symptoms were actually due to AF. AS might be the consequence of a high burden of risk factors and comorbidities, which might contribute to a high symptom burden even in patients without AF.

The question why some patients suffering

Conclusion

AS contributes to a high symptom burden in patients with AF. Because increased AS might also be the consequence of a high burden of cardiovascular risk factors and comorbidities, increased AS itself might contribute to symptoms, even between AF episodes, when patients are in sinus rhythm, which might explain why patients with paroxysmal AF often report continuous symptoms. Moreover, increased AS might be a surrogate for subclinical left ventricular diastolic dysfunction and could therefore be

Acknowledgements

Special thanks to Prof Borggrefe for the initial idea and impulse for the conception of the study.

Funding Sources

The authors have no funding sources to declare.

Disclosures

The authors have no conflicts of interest to disclose.

References (28)

  • S.E. Kjeldsen et al.

    Arterial stiffness predicts incident atrial fibrillation in the Framingham Heart Study: a mechanistic contribution in people with high blood pressure or history of hypertension

    Hypertension

    (2016)
  • L.Y. Chen et al.

    Carotid intima-media thickness and arterial stiffness and the risk of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study, Multi-Ethnic Study of Atherosclerosis (MESA), and the Rotterdam Study

    J Am Heart Assoc

    (2016)
  • S. Fumagalli et al.

    Atrial fibrillation after electrical cardioversion in elderly patients: a role for arterial stiffness? Results from a preliminary study

    Aging Clin Exp Res

    (2016)
  • D.H. Lau et al.

    Aortic stiffness in lone atrial fibrillation: a novel risk factor for arrhythmia recurrence

    PLoS One

    (2013)
  • Cited by (6)

    See editorial by Hermans et al., pages 1843–1846of this issue.

    See page 1954 for disclosure information.

    View full text