Noninvasive peripheral vascular function and atrial fibrillation in the general population

Börschel, Christin S.; Rübsamen, Nicole; Ojeda, Francisco; Wild, Philipp S.; Hoffmann, Boris; Prochaska, Jürgen H.; Gori, Tommaso; Lackner, Karl J.; Blankenberg, Stefan; Zeller, Tanja; Münzel, Thomas; Schnabel, Renate B.

doi:10.1097/hjh.0000000000002000

Cited by 11 publications

(9 citation statements)

References 49 publications

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“…The results are consistent with other studies looking at FMD in hypertension and AF individually and confirms that endothelial dysfunction is present. 9,[13][14][15][16]21 Our findings extend previous work by demonstrating that the presence of AF generally does not incrementally worsen endothelial dysfunction, nor was AF an independent predictor of endothelial dysfunction on multivariate analysis. However, permanent AF compared to paroxysmal AF does have significantly worse FMD parameters with permanent AF being an independent predictor on multivariate analysis.…”

Section: Discussionsupporting

confidence: 78%

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A greater burden of atrial fibrillation is associated with worse endothelial dysfunction in hypertension

et al. 2020

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Atrial fibrillation (AF) and hypertension often co-exist and both are associated with endothelial dysfunction. We hypothesised that AF would further worsen endotheliumdependent flow-mediated dilatation (FMD) in hypertension patients compared to those without AF. In a cross-sectional comparison, we measured brachial artery diameter at rest and during reactive hyperaemia following 5 minutes of arterial occlusion in two patient groups: AF (and hypertension) (n = 61) and hypertension control groups (n = 33). The AF (and hypertension) subgroups: permanent AF (n = 30) and paroxysmal AF (n = 31) were also assessed. The permanent AF patients received heart rate and blood pressure (BP) control optimisation and were then followed up after eight weeks for repeat FMD testing. There was no significant difference in FMD between AF (and hypertension) group and hypertension control group (4.6%, 95% CI [2.6 -5.9%] vs 2.6%, 95% CI [1.9 -5.3%]; p=0.25).There was a significant difference in FMD between permanent AF and paroxysmal AF groups (3.1%, 95% CI [2.3 -4.8%] vs 5.9%, 95% CI [4.0 -8.1%]; p=0.02). Endothelium-dependent FMD response showed a non-significant improvement trend following eight weeks of heart rate and BP optimisation (3.1%, 95% CI [2.3 -4.8%] (baseline) vs 5.2%, 95% CI [3.9 -6.5%] (follow up), p=0.09). Presence of AF generally does not incrementally worsen endothelial dysfunction in hypertension patients, although the duration and frequency of AF (paroxysmal AF to permanent AF) does lead to worsening endothelial function. Eight weeks of BP optimisation did not significantly improve endothelial dysfunction as measured by FMD.

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Section: Discussionsupporting

confidence: 78%

“…[9][10][11][12] FMD is also found to be impaired in patients with AF. [13][14][15][16] Since AF and hypertension, commonly co-exist, we hypothesised that endothelium-dependent FMD will be reduced in patients with AF (and hypertension) compared to hypertensive controls and this may partly explain the poor prognosis in such patients.…”

Section: Introductionmentioning

confidence: 99%

A greater burden of atrial fibrillation is associated with worse endothelial dysfunction in hypertension

et al. 2020

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“…Several studies have shown that endothelial dysfunction in terms of reduced NO activity is one of the earliest markers in patients with atherogenic risk factors [7,[49][50][51]. Endothelial dysfunction, as demonstrated by endothelial-dependent flow-mediated dilatation (FMD) has also been shown to be present in AF [52][53][54][55][56][57]. Plasma von Willebrand factor (vWF), a marker of endothelial damage/dysfunction is consistently elevated in AF and has been associated with adverse outcomes [58].…”

Section: Endothelial Function In Afmentioning

confidence: 99%

Endothelial function in patients with atrial fibrillation

et al. 2020

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Atrial fibrillation (AF) is the most common heart arrhythmia and is associated with poor outcomes. The adverse effects of AF are mediated through multiple pathways, including endothelial dysfunction, as measured by flow-mediated dilatation. Flow-mediated dilatation has demonstrated endothelial dysfunction in several conditions and is associated with poor outcomes including mortality, yet can be improved with medical therapy. It is thus a useful tool in assessing endothelial function in patients. Endothelial dysfunction is present in patients with AF and is associated with poor outcomes. These patients are generally older and have other co-morbidities such as hypertension, hypercholesterolaemia and diabetes. The precise process by which AF is affiliated with endothelial damage/dysfunction remains elusive. This review explores the endothelial structure, its physiology and how it is affected in patients with AF. It also assesses the utility of flow mediated dilatation as a technique to assess endothelial function in patients with AF. KEY MESSAGESEndothelial function is affected in patients with atrial fibrillation as with other cardiovascular conditions. Endothelial dysfunction is associated with poor outcomes such as stroke, myocardial infarction and death, yet is a reversible condition. Flow-mediated dilatation is a reliable tool to assess endothelial function in patients with atrial fibrillation. Patients with atrial fibrillation should be considered for endothelial function assessment and attempts made to reverse this condition.

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“…A frequently used measure of peripheral artery endothelial function relates to the flow‐mediated dilation (FMD). Several studies support the notion that AF patients demonstrate an impaired FMD 7,8 . Indeed, Komatsu et al found that FMD also related to AF severity, with an FMD of 6.5 ± 3.5% in non‐AF individuals, 5.4 ± 2.6% in paroxysmal AF patients, and 4.3 ± 2.1% in chronic AF patients 9 .…”

Section: Endothelial Dysfunction and Vascular Maladaptation In Primary Prevention Of Afmentioning

confidence: 80%

“…Several studies support the notion that AF patients demonstrate an impaired FMD. 7,8 Indeed, Komatsu et al found that FMD also related to AF severity, with an FMD of 6.5 ± 3.5% in non-AF individuals, 5.4 ± 2.6% in paroxysmal AF patients, and 4.3 ± 2.1% in chronic AF patients. 9 A 1% drop in FMD relates to a 13% increase in cardiovascular risk.…”

Section: Endothelial Dysfunction and Vascular Maladaptation In Primmentioning

confidence: 99%

Endothelial dysfunction and vascular maladaptation in atrial fibrillation

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Boidin

Buckley

et al. 2021

Eur J Clin Investigation

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Atrial fibrillation (AF) is the most common clinically significant arrhythmia. 1 The clinical consequences of AF relate to an increased risk of mortality and morbidity from stroke, heart failure and death. 2 Even short episodes of AF are associated with atrial myocardial damage, expression of prothrombotic factors, activation of platelets and inflammatory cells, collectively contributing to a generalised prothrombotic state and, subsequently, increased risk for clinical events. 3 Several studies have examined the complex and, most likely, multi-faceted aetiology of AF, with a likely central role for inflammation. 4 The presence of a systemic inflammatory, prothrombotic state may also contribute to the higher risk for comorbidities. 5 Interestingly, the presence of cardiovascular risk factors, but also inflammation, has previously been related to the presence of vascular dysfunction. 6 Hence, this review poses that endothelial dysfunction may contribute to

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Noninvasive peripheral vascular function and atrial fibrillation in the general population

Cited by 11 publications

References 49 publications

A greater burden of atrial fibrillation is associated with worse endothelial dysfunction in hypertension

A greater burden of atrial fibrillation is associated with worse endothelial dysfunction in hypertension

Endothelial function in patients with atrial fibrillation

Endothelial dysfunction and vascular maladaptation in atrial fibrillation

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