G.Pelagalli¹, A. Masi¹, M.Migliorini¹, F.M. Nigro¹, S. Boni¹, S. Pupo¹, M.V. Silverii¹, C. Del Serio¹, S. Fumagalli¹. – ¹ Unità di Terapia Intensiva Geriatrica e Unità di Aritmologia Geriatrica, Università di Firenze e AOU Careggi, Firenze, Italia.
Introduction. Atrial fibrillation (AF) and arterial stiffness (AS) alterations greatly increase with age. Both conditions influence left ventricular (LV) function. Aims of this study were to evaluate if AS and peripheral arterial disease (PAD) can play a synergistic role on LV performance of patients undergoing electrical cardioversion (ECV) of persistent AF.
Methods. All elective consecutive patients undergoing ECV in a Day-Hospital setting were enrolled. There were no exclusion criteria. The Mini-Mental State Examination (MMSE), the Short Physical Performance Battery (SPPB) and the Geriatric Depression Scale (GDS) were used to measure neurocognitive and functional profile, and depressive symptoms, respectively. After ECV, AS was assessed with the Cardio-Ankle vascular Index (CAVI), and LV performance with longitudinal strain (LS), a parameter derived from speckle-tracking echocardiography.
Results. We enrolled 82 patients (age: 76+8 years; men: 67.1%); in 38 of them, AF was related to a bradycardia-tachycardia syndrome or hypertension, or it could be defined a lone atrial fibrillation (No-CHF). In 44 patients, the arrhythmia was due to a structural myocardial disease (i.e., myocardial infarction, valvular disease, systolic heart failure) (CHF). LV ejection fraction (EF; 55+14 vs. 66+7%, p<0.001) and LS (-15.0+4.6 vs. -17.7+3.7, p=0.009) were lower in the CHF group; however, no differences were observed for AS (CAVI – No-CHF: 9.7+1.3 vs. CHF: 9.9+1.6, p=0.553). ECV restored sinus rhythm in 92.7% of patients. In multivariate analysis, in No-CHF group, LV performance was inversely associated to body height (p<0.001) and to the presence of signs and symptoms of heart failure due to AF (p=0.008). LS was directly related to CAVI (p=0.038). In univariate analysis, in CHF group, PAD (-11.1+5.9 vs. -16.0+3.8, p=0.006), coronary artery disease (p=0.021), AF length >3 months (p=0.029) and the presence of a permanent pacemaker (p<0.001) were associated to lower LS values. EF was directly associated to LS in CHF group (p<0.001), but not in No-CHF group (p=0.123). Multivariate analysis confirmed the significant role of EF (p<0.001) and PAD (p=0.019) to predict LS values. It was observed a direct association between LS and MMSE (p=0.046) and SPPB (p=0.004) scores only in the CHF group. Interestingly, EF did not show a similar behavior.
Conclusions. In patients with persistent AF undergoing ECV, the role of AS and PAD seems to be different according to the presence of structural heart disease. In the No-CHF group, LS is directly associated with AS, which proves to be an important risk factor for arrhythmia relapse and heart failure. In CHF patients, PAD is related to a worse LV performance; furthermore, in this group, LS values are associated to physical and neuro-cognitive profile.
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